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

\u201cTymectomy for myasthenia gravis: a 27 year experience\u201d

OBJECTIVE: Thymectomy is considered an effective therapeutic option for patients with myasthenia gravis (MG). We reviewed our 27-year experience with surgical treatment of MG with respect to long-term results and factors affecting outcome. METHODS: Between 1970 and 1997, we performed 232 thymectomies for MG. Fifteen patients were lost to follow-up; the remaining 217 form the object of our study. Sixty-two patients (28.4%) had thymoma. Myasthenia was graded according to a modified Osserman classification: 51 patients (23.5%) were in class I, 81(37.3%) in class IIA, 52 (24%) in class IIB, 26 (12%) in class III and seven (3.2%) in class IV. Mean duration of symptoms before the operation was 12+/-10 months. Fifty-eight thymectomies for thymoma were performed through a median sternotomy and four through a clamshell incision. Forty-six thymectomies for non-thymomatous MG were performed through a standard cervicotomy, 101 procedures through a partial upper sternal-splitting incision and eight through a complete median sternotomy. RESULTS: Operative mortality was 0.92% (two patients). After a mean follow-up of 119 months, 71% of all patients improved their clinical status (25% without medications and asymptomatic; 46% with a reduction of medications and/or clinically improved); 39 (18%) have a stable disease with no clinical modifications; 12 (5%) presented a deterioration of their clinical status with worse symptoms, required more medications, or both. Thirteen patients (6%) died because of MG (mean survival 34.3+/-3.6 months). The presence of a thymoma negatively influenced the prognosis. Younger patients showed a more favorable outcome as well as patients with a shorter duration of symptoms before the operation; patients with lower classes of myasthenia showed a higher rate of remission. CONCLUSIONS: Thymectomy is effective in the management of patients with MG at all stages with low morbidity. Patients with thymoma present a less favorable outcome