Towards fair and clinically relevant polygenic predictions.

Lennon et al. recently proposed a clinical polygenic score (PGS) pipeline as part of the Electronic Medical Records and Genomics (eMERGE) network initiative. In this spotlight article we discuss the broader context for the use of PGS in preventive medicine and highlight key limitations and challenges facing their inclusion in prediction models.

Accuracy of Online Artificial Intelligence Models in Primary Care Settings.

INTRODUCTION: The importance of preventive medicine and primary care in the sphere of public health is expanding, yet a gap exists in the utilization of recommended medical services. As patients increasingly turn to online resources for supplementary advice, the role of artificial intelligence (AI) in providing accurate and reliable information has emerged. The present study aimed to assess ChatGPT-4's and Google Bard's capacity to deliver accurate recommendations in preventive medicine and primary care. METHODS: Fifty-six questions were formulated and presented to ChatGPT-4 in June 2023 and Google Bard in October 2023, and the responses were independently reviewed by two physicians, with each answer being classified as "accurate," "inaccurate," or "accurate with missing information." Disagreements were resolved by a third physician. RESULTS: Initial inter-reviewer agreement on grading was substantial (Cohen's Kappa was 0.76, 95%CI [0.61-0.90] for ChatGPT-4 and 0.89, 95%CI [0.79-0.99] for Bard). After reaching a consensus, 28.6% of ChatGPT-4-generated answers were deemed accurate, 28.6% inaccurate, and 42.8% accurate with missing information. In comparison, 53.6% of Bard-generated answers were deemed accurate, 17.8% inaccurate, and 28.6% accurate with missing information. Responses to CDC and immunization-related questions showed notable inaccuracies (80%) in both models. CONCLUSIONS: ChatGPT-4 and Bard demonstrated potential in offering accurate information in preventive care. It also brought to light the critical need for regular updates, particularly in the rapidly evolving areas of medicine. A significant proportion of the AI models' responses were deemed "accurate with missing information," emphasizing the importance of viewing AI tools as complementary resources when seeking medical information.

Aligning Prevention Evidence Gaps With Prevention Research.

This Viewpoint describes the development of tools to communicate actionable steps to address research needs and gaps for USPSTF recommendations that have insufficient evidence to make definitive guidance.

Training and career opportunities for residencies in Hygiene and Preventive Medicine: results of a survey on 39 Italian schools.

INTRODUCTION: The Italian National Health Service (SSN) is currently grappling. with a complex situation, characterized by a persistent shortage of medical personnel and the divergent aspirations of young medical graduates. Additionally, recent regulatory developments concerning specialist training further contribute to the intricacies of the landscape, calling for a comprehensive analysis of the challenges and opportunities within the sector. This study aims to provide an updated overview of the current placement of medical graduates, residents and specialists in the specific hygiene and preventive medicine (Public Health) field. METHODS: Data on admissions, withdrawals and resignations were obtained from the Ministries of Universities and Health and from the archives of the "Associazione Liberi Specializzandi" (ALS). Information regarding the professional prospects for specialists and residents in the field of Public Health was gathered through a tailored survey conducted by the "Consulta dei Medici in Formazione Specialistica" (Council of Medical Residents) of the Italian Society of Hygiene (SItI). RESULTS: In 2022, a total of 483 specialization contracts were granted, indicating a decrease of 37% compared to the previous year. Notably, 85 positions (17.6%) remained unallocated or resulted in dropouts. Six months after completing their residency, 1.5% of hygiene residents were still actively seeking employment. On a positive note, 75.4% of fourth-year residents secured contracts under the "Decreto Calabria". Career opportunities within the Italian SSN have witnessed growth, with a significant proportion of placements in territorial services and hospital medical directorates. DISCUSSION AND CONCLUSIONS: The updating of training programs provided by residency schools and the exploration of innovative approaches are of paramount importance to address the urgent need for high-quality training and to cater to the requirements of the national health system.

Current treatment options for cluster headache: limitations and the unmet need for better and specific treatments-a consensus article.

AIM: Treatment for cluster headache is currently based on a trial-and-error approach. The available preventive treatment is unspecific and based on few and small studies not adhering to modern standards. Therefore, the authors collaborated to discuss acute and preventive treatment in cluster headache, addressing the unmet need of safe and tolerable preventive medication from the perspectives of people with cluster headache and society, headache specialist and cardiologist. FINDINGS: The impact of cluster headache on personal life is substantial. Mean annual direct and indirect costs of cluster headache are more than 11,000 Euros per patient. For acute treatment, the main problems are treatment response, availability, costs and, for triptans, contraindications and the maximum use allowed. Intermediate treatment with steroids and greater occipital nerve blocks are effective but cannot be used continuously. Preventive treatment is sparsely studied and overall limited by relatively low efficacy and side effects. Neurostimulation is a relevant option for treatment-refractory chronic patients. From a cardiologist's perspective use of verapamil and triptans may be worrisome and regular follow-up is essential when using verapamil and lithium. CONCLUSION: We find that there is a great and unmet need to pursue novel and targeted preventive modalities to suppress the horrific pain attacks for people with cluster headache.

Redictive variables of compliance with preventive Behaviors during the covid-19 pandemic / Variables predictoras del cumplimiento de medidas preventivas durante la pandemia de COVID-19

Con la propagación de la COVID-19 en todo el mundo, los comportamientos preventivos asumieron un papel clave en la contención del virus. En España, el Ministerio de Salud aprobó un confinamiento de la población de 14 semanas a nivel nacional, del 15 de marzo al 20 de junio de 2020. Aproximadamente un mes después del confinamiento, del 10 al 16 de abril, el presente estudio analizó la percepción de riesgo en función de la edad y el sexo y su relación con el cumplimiento de la conducta preventiva frente a la propagación de la COVID-19. La muestra estuvo constituida por 535 participantes (67,9% mujeres) distribuidos en dos grupos de edad: (42,4%) clasificados como jóvenes (18-23 años) y (57,5%) como adultos (40-65 años). Los datos se recopilaron a través de un cuestionario en línea ad hoc. Los resultados indicaron que la percepción de temor/ansiedad y la edad predecían la adopción de medidas preventivas. Nuestro estudio concluye que los jóvenes y las personas que experimentan menos emociones de temor/ansiedad ante la COVID-19 adoptan menos comportamientos preventivos para la salud.(AU)

With the spread of COVID-19 worldwide, preventive behaviors took on a key role in virus containment. In Spanish, the Ministry of Health approved a 14-week nationwide population lockdown from March 15th to June 20th, 2020. Approximately one month after the lockdown, from April 10th to 16th, the present study analyzed the risk perception based on age and gender and its relationship with preventive behavior compliance against the spread of COVID-19. The sample was constituted by 535 participants (67.9% women) distributed in two age groups: (42.4%) classified as young people (18-23 years) and (57.5%) as adults (40-65 years). Data were co-llected through an ad hoc online questionnaire. The results indicated that the perception of fear/anxiety and age predicted the adoption of preventive behaviors. Our study concludes that young people and people who experience less fear or anxiety of COVID-19 adopt fewer preventive health behaviors.(AU)