Assessment of COVID-19 pandemic impact on guaranteeing food security in local school catering

Background. The Italian National Institute of Statistics (ISTAT) highlights that in 2020 10% of the Italian population could not afford an adequate meal every 2 days. Families with several children were more affected, for these children school meals represented the only access to a healthy diet. The European Commission Farm to Fork Strategy, concerning the COVID-19 pandemic (CP), underlines the need to act to ensure access to a sufficient supply of affordable food for all. In the Province of Trieste (PT) over 90% of pupils eat in school canteens (12,000 meals per day). The aims of the project were to verify the impact of CP on the food security of public school canteens (PSC) and determine any Nutritional Critical Points (NCPs) - Corrective Actions (CAs) to guarantee healthy equity meals for all pupils. Methods. The content of Public food procurement and service polices for a healthy diet (PFP) published by the WHO and the Nutrient Analysis Critical Control Points (NACCP) process as indicated by the Ministry of Health were applied. In the first quarter of 2021, all food procurement contracts (n = 6) and all of the school kitchens (n = 45) of PT PSC were verified, the University of Trieste analysed the composition of fresh desserts administered in 7 consecutive weeks. Results. The NACCP process showed NCPs on the low quality of afternoon snacks and on the quantitative/qualitative fat profile of fresh desserts, with a content of 69 to 72% of saturated fat, of 5 to 7% of trans fat and of 8 to 12% oxidized fat as a “dual quality” food. CAs were activated to support all PT PSC in reformulating fresh desserts, as well as in aiding the assessment of the food procurement landscape, activating regular monitoring of compliance and designing procurements adherent to PFP. Conclusions. Project outcomes highlight the importance of taking action to continuously support PSC in order to ensure healthy and equitable food environments for all and to contribute to building a resilient food system. Key messages. Guarantee healthy equity school meals for all pupils by developing on going processes to address the pandemic challenge. Ensure technical assistance to school catering to overcome the impact of COVID–19

Integrated guide for public procurement and private contracts of collective catering system and SDGs

Surveys (2008-2018) carried out by the Local Health Agency of Trieste (ASUITS) in local collective catering (CC) services of schools, hospitals, nursing homes, and workplaces (25.000 daily meals) have shown some non - adherence to healthier food choices, food standards, procedures and green and social procurement as recommended by the WHO, FAO, UE, Ministry of Health and of Environment. The purpose of this project is to support local public and private organizations in transforming the national and regional catering services food standards related to health, nutrition, environment and social criteria into food procurement and food contracts specifications. This has been done by compiling the major obstacles to improved standards observed during surveys, and by sharing critical and relevant examples with major public contractors across local, regional and national level. The guidelines (GL) for public procurement of CC consist of five chapters: the elaboration of specifications; a response module to present the offer of services; selection and award criteria, an evaluation system of offers, and the technical specifications attached. Technical information fixes the constituent elements of the service in order to have similar and directly comparable offers. GL cover both the purchasing of food and the contracting of catering services. In this way public or private institutions are able to prepare tender documents suitable to respond to health, economic needs and Sustainable Development Goals (SDGs). The development of the GL has increased the awareness and real potential that local organizations have in enhancing the strategic use of purchasers to boost food qualification, jobs, growth and investment. As well as to create a more innovative economy, to be resource and energy efficient, and to be socially-inclusive. To meet population nutrient intake goals and SDGs it is necessary to increase co-operation and the sharing of the objectives of ’Health in All Policies’

Evaluation, recommendation and implementation of the local hospital catering system

According to the literature the prevalence of the risk of malnutrition o hospitalized people exceeds 25% of patients, this evidence is also related to low meal satisfaction. To reduce hospital malnutrition it is also important to improve the consumption of meals by implementing organoleptic and nutritional quality (O&NQ). The Local Health Agency of Trieste (ASUITS) has conducted surveys to find out how to evaluate and improve the procurement qualifications of hospital catering systems (HCS) and how to implement O&NQ. The production processes of meals served in two clinics using Cook Chill (CC) and Cook/Fresh - Hot Hold (CFHH) production process, respectively, were evaluated from 2017 - 2019. The Nutrient Analysis Critical Control Point process was applied for the evaluation of two catering systems. In addition, the antiradicalic power (ARP) of 120 samples of meals by the University of Trieste was analysed. In 2019 an investigation was conducted to compare the satisfaction and ARP content of meals served to patients in two hospital wards (N = 60). The meals to patients of two wards respectively with CC Cold Plating Retherm (PR) and CC Hot PR were served. Meals produced by the CC production process highlight the average loss of 50% of ARP compared to the CFHH. Meals produced by the CC Cold PR method limit the loss of ARP by 15-40% less compared to the CC Hot PR method. The satisfaction of patients who have consumed meals produced by the CC Cold PR method is double compared to that of patients who have consumed meals produced by the CC Hot PR method. The surveys have produced significant evidence to evaluate hospital meal production processes and to improve O&NQ. The results were used to develop recommendations for the drafting of tender specifications capable of also protecting nutritional variables. The evaluation of the O&NQ of HCS represents a central determinant of food safety and nutrition security and must be taken into consideration in the procurements procedure

Recommendations and tools to implement food and nutrition policies for collective catering

Surveys (2015 – 2018) carried out by the local health agency of Trieste (LHATs) in a collective catering (CC) sample (nurseries, schools, university, hospitals, nursing homes, workplaces), with a total production of 20% of the meals served daily in the area, have shown some critical conditions. In some CC the following has been observed: noncompliance of food supply quality and quantity, loss of up to 80% of antiradicalic power (ARP) and poliphenol content of several vegetable dishes, increase of more than 50% of oxidized compounds in some fish and homogenized meat dishes, as demonstrated by the University of Trieste. This represents a triple burden for the community: consumption of non-protective meals from oxidative stress; fraud of product quality/quantity (equal to 2-4% of contract value); and failure of the challenges of Sustainable Development Goals (SDGs). It is also a serious problem for institutionalized and hospitalized people as, according to the literature, the prevalence of the risk of malnutrition in patients exceeds 50% and 25% respectively. In view of these findings, LHATs has developed recommendations and tools to improve the control capability of organizations that outsource the CC. These recommendations take into consideration: analysis of item costs, merceological food value, working conditions, and integrate the indications of the Ministry of Health for CC that provide: adoption of dietary guidelines, Nutrient Analysis Critical Control Points (NACCP) process and updated food composition. Tools recommended by LHATs permit monitoring and control food supply quality-quantity, NACCP process, ARP and other markers to detect the nutritional value of meals. The key process to developing actions to better apply food and nutrition policies and to contribute to SDGs in strategic local CC is the ability of the public health to analyze its context in a systemic view to innovative provision of improve sustainable healthy protective nutrition for communities

"Delirium Day": A nationwide point prevalence study of delirium in older hospitalized patients using an easy standardized diagnostic tool

Background: To date, delirium prevalence in adult acute hospital populations has been estimated generally from pooled findings of single-center studies and/or among specific patient populations. Furthermore, the number of participants in these studies has not exceeded a few hundred. To overcome these limitations, we have determined, in a multicenter study, the prevalence of delirium over a single day among a large population of patients admitted to acute and rehabilitation hospital wards in Italy. Methods: This is a point prevalence study (called "Delirium Day") including 1867 older patients (aged 65 years or more) across 108 acute and 12 rehabilitation wards in Italian hospitals. Delirium was assessed on the same day in all patients using the 4AT, a validated and briefly administered tool which does not require training. We also collected data regarding motoric subtypes of delirium, functional and nutritional status, dementia, comorbidity, medications, feeding tubes, peripheral venous and urinary catheters, and physical restraints. Results: The mean sample age was 82.0 \ub1 7.5 years (58 % female). Overall, 429 patients (22.9 %) had delirium. Hypoactive was the commonest subtype (132/344 patients, 38.5 %), followed by mixed, hyperactive, and nonmotoric delirium. The prevalence was highest in Neurology (28.5 %) and Geriatrics (24.7 %), lowest in Rehabilitation (14.0 %), and intermediate in Orthopedic (20.6 %) and Internal Medicine wards (21.4 %). In a multivariable logistic regression, age (odds ratio [OR] 1.03, 95 % confidence interval [CI] 1.01-1.05), Activities of Daily Living dependence (OR 1.19, 95 % CI 1.12-1.27), dementia (OR 3.25, 95 % CI 2.41-4.38), malnutrition (OR 2.01, 95 % CI 1.29-3.14), and use of antipsychotics (OR 2.03, 95 % CI 1.45-2.82), feeding tubes (OR 2.51, 95 % CI 1.11-5.66), peripheral venous catheters (OR 1.41, 95 % CI 1.06-1.87), urinary catheters (OR 1.73, 95 % CI 1.30-2.29), and physical restraints (OR 1.84, 95 % CI 1.40-2.40) were associated with delirium. Admission to Neurology wards was also associated with delirium (OR 2.00, 95 % CI 1.29-3.14), while admission to other settings was not. Conclusions: Delirium occurred in more than one out of five patients in acute and rehabilitation hospital wards. Prevalence was highest in Neurology and lowest in Rehabilitation divisions. The "Delirium Day" project might become a useful method to assess delirium across hospital settings and a benchmarking platform for future surveys

Single switch configuration of loaded line phase shifter

A novel configuration of loaded line phase shifter is presented. This structure exhibits the interesting properties to halve the number of semiconductor switches and to reduce the size. An analytic approach is utilised to derive the equations for the scattering parameters. The proposed circuit is successfully compared with a standard loaded line two devices phase shifter

Baroque personae

Chicago357 p.: index; 23 c

Nutritional critical points of the cook & chill system and development of corrective actions tools

Background. In Italy almost one in 10 people eat a meal in collective catering (CC) every day. The WHO and FAO emphasize the need to guarantee adequate amounts of antioxidants and protective phytochemicals, essential for the many metabolic functions, by intake of minimally processed foods. It is strategic to ensure protective meals for all CC users, especially hospital patients and the elderly. Recently the Public Procurement (PP) have more often chosen Cook & Chill (C&C) systems, characterized by the administration of meals stored between 0 and +3 C ° for 20 - 30 days. The aims of the project were to: evaluate the qualitative - quantitative profile of the effective protective molecules in C&C meals, determine any nutritional critical points (NCPs) - corrective actions (CAs) of C&C, identify rapid and cheap methods for monitoring the nutritional quality of meals and identify portable systems easy to use by non-professional operators in the chemical-analytical sector. Methods. The NACCP process indicated by the Ministry of Health has been applied. In 2019 over 120 foods collected at different stages of the production of a C&C were sampled. The University of Trieste has performed over 850 analyses. The outcomes were compared with the food composition database by the agency of the Ministry of Agriculture (MA). Results. The quantitative profile of the protective molecules present in C&C meals was in many cases reduced by 15 to 75% compared to the MA database. The protective capacity of some meals administered is comparable to that of ultra-processed food. The NCPs - CAs have been determined to ensure an adequate content of protective compounds in C&C meals. Rapid screening systems with chromatographic and optical techniques were identified. Portable systems with immediate analytical response will be developed. Conclusions. The results of the project can significantly orient PP towards choices that: adhere to the WHO recommendations and adopt nutritional quality monitoring tools. Key messages. Include nutritional quality criteria for choosing collective catering systems. Monitor the nutritional quality of collective catering through rapid screening systems

Recherches sur l’histoire des paysages du Vietnam central. Le marché des sources (nguồn) et les routes de montagne du plateau d’An Khê

Hardy Andrew, Barocco Frederico, Nguyễn Đặng Anh Minh, Nguyễn Đình Hưng, Nguyễn Quan g Ngọc, Nguyễn Tiến Đông, Wisniewski Béatrice. Recherches sur l’histoire des paysages du Vietnam central. Le marché des sources (nguồn) et les routes de montagne du plateau d’An Khê. In: Bulletin de l'Ecole française d'Extrême-Orient. Tome 106, 2020. pp. 323-362