The current epidemiological situation proves how the information on causes of death and co-existing health conditions are important for better understanding of health tendencies in our societies and for establishing effective health policies. But the quality of data on causes of death raises deep concerns in several European countries. This is mostly due to individual practices of medical doctors who are unaware of certification rules imposed by the World Health Organisation (WHO) and national statistical offices and, when stating the death, fill in death certificates incorrectly or carelessly. In most European countries, students of medical universities devote less than 2 hours (during the whole curriculum) to certification rules, whereas practising medical doctors have few opportunities of improving and updating their skills in filling in death certificates. As a result, in several countries of Europe considerable proportion of deaths is assigned to unknown or ill-defined causes: in 2018 it was 12% in Greece, 25% in Poland, 8% in Portugal.For several decades now, the World Health Organisation (WHO) has been establishing in-detailed recommendations about registering, coding and publishing information on causes of death, which are adopted by most developed countries, therein all EU member states.The proposed project aims at developing new innovative pedagogies that concern the rules of WHO as well as good practices introduced in selected European countries characterised by a relatively high quality of cause-of-death statistics. Its objective is twofold; first, it consists of providing an innovative learning tool (CODA) for lecturers training medical students, giving them the opportunity to improve their knowledge on WHO’s recommendations and rules concerning the certification of causes of death. Second, it creates a MOOC dedicated to trainers and professors of various universities and institutes who wish to adapt the CODA tool for their teaching purposes and share it with their students.Teaching activities performed within the project include providing e-learning courses to academics (lecturers, professors) at medical universities in Europe, in order to 1) improve their understanding of epidemiological tendencies in ageing populations, with special reference to the mortality by causes of death, 2) show the importance of good quality of mortality statistics for better understanding of epidemiological tendencies and health policy impacts within a population; 3) provide them with the WHO recommendations concerning filling in death certificates; 4) improve their competencies and skills in filling in death certificates, 5) discuss the most frequent causes of death that should not be, according to WHO, used, 6) improve their digital competencies and promote innovative e-learning. Six editions of the course will be dedicated to overall 550 participants, therein approximately 80% represented by the teachers at medical universities, and approximately 20% represented by academics in other domains (i.e. public health, epidemiology, demography) and medical doctors. At the end of the course, each participant will pass an evaluation based on the CODA tool and, if successful, will receive a MOOC Statement of Accomplishment. This will contribute to a better recognition of skills in the domain of medical documentation and WHO's certification rules.Subsequently, the participants of the course will be encouraged to create their own MOOC courses based on the CODA tool for their teaching purposes and to share it with their students, the future generations of medical doctors. Thus, the long-term impact consists of improving individual practices in cause-of-death certification, performed by medical doctors, and subsequently, improving the quality of cause-of-death data necessary for efficient health policies.The impact of the course will not be limited to trainers of medical universities enrolled in the project. We ensure that the educative materials (including CODA) are published, in several language versions (English, French, Greek, Polish, Portuguese), at the European open resource platform for free once the project is finished. Thus, the educative materials will be available to anyone willing to increase the knowledge in recent trends in mortality by causes, as well to improve the competencies in establishing the medical documentation. Also, three multiplier events organised within the project are supposed to sensibilize the wide audience (medical personnel, stakeholders, public opinion) on the importance of good, informative and correct public statistics in ageing societies, as well as to promote the knowledge on current epidemiological tendencies and processes in Europe.

European Coronary Heart Disease (CHD) burden is unsustainable. Better risk stratification tools and personalized care of patients are needed for reducing morbidity and mortality of CHD and the associated economic burden. To this end we have planned to shape and implement a personalized secondary prevention program for patients with established CHD. This precision strategy will be tested in a prospective trial, the CoroPrevention Trial, a central element of our proposal. We aim to significantly reduce the numbers of coronary events by using outcome risk- and patient characteristics- guided prevention in CHD patients. 1. Prospectively evaluate clinical utility of personalized prevention in CHD 2. Evaluate health economic and social benefits of the personalized prevention in CHD 3. Discover predictive markers of drug treatment response in CHD 4. Improve current ESC guidelines based on RCT validated clinical data 5. Disseminate the refined prevention program to the attention of practitioners, patients, health care payers and policy makers This program will establish a new economically sustainable personalized treatment practice applicable throughout Europe particularly to those regions where CHD prevention needs upgrading. The used protocols and technologies will carefully assessed by NICE using their standard evaluation methods that will allow independent expert opinions for different European authorities and decision makers. These opinion statements will further be supported by full Health Economics analyses of CoroPrevention Trial.

Despite the fact that antithrombotic therapy (ATT) has little or even negative effects on the well-being of cancer patients during their last year of life, stopping ATT is rare in clinical practice. In contrast, ATT is often continued until death, resulting in excess bleeding, higher healthcare costs, and increased disease burden. SERENITY will develop an information-driven, palliative care shared decision-making process enabled by a user-friendly, easily accessible, web-based shared decision support tool (SDST) that will facilitate treatment decisions regarding appropriate use of ATT in cancer patients at the end of life. SERENITY will use a comprehensive approach consisting of a combination of realist review, flash mob research, three epidemiologic studies in NL, UK, and DK, and qualitative interviews. The results of these studies will be used in a Delphi process to reach consensus on the optimal design of the intervention. Using the consensus reached in the Delphi process, the SDST will be designed to be patient-specific with adaption to gender, cancer-related, cultural, and socioeconomic factors. Proceeding, the SDST will be tested and optimised in a Randomised Clinical Trial. A targeted implementation and exploitation plan will be developed to enable the use of the SERENITY approach across Europe, as well as incorporation in national and pan-European clinical guidelines and policies. The intervention will ultimately lead to appropriate use of ATT, prevention of bleeding complications, and considerable cost savings in addition to improved quality of life and treatment satisfaction of patients, their carers, and involved healthcare professionals. The intervention will empower cancer patients and their carers, enabling them to make their own choices. The intervention will reduce the disease burden of hundreds of thousands of people living with cancer receiving palliative care each year, throughout all EU regions.

Exposure to multiple endocrine disrupting chemicals (EDC) is an environmental insult that interferes with the development and function of the endocrine system, governed by the hypothalamus-pituitary (HP) axis. This interaction is specially concerning in developmental stages of life, such as the perinatal period and puberty. Despite the current body of knowledge on EDC actions on the endocrine system, a comprehensive, holistic understanding of the impact on the HP axis is still lacking. HYPIEND aims to understand the effects of EDC co-exposure in the function and epigenetic programming of the HP axis to delineate interventional strategies for minimizing exposure and consequences on the neuroendocrine system during the perinatal and pre-pubertal stages. To do that, a computational toxicology methodological framework will be built leveraging public data and state of the art data analysis techniques to define EDC co-exposure patterns in target population. The resulting patterns will be evaluated in a sequential tiered approach consisting in cell-based screenings, Danio rerio models of HP axes, in vitro, in silico and in vivo models of placenta and blood brain barrier diffusion and new models of organoids-based organ-on-chip recapitulating the HP axis. EDC effects on epigenetic programming will be evaluated in preclinical models of perinatal and early childhood. Whole genome DNA methylation patterns in the different models will be explored as a source of non-invasive biomarkers of HP axis disruption by EDC. The knowledge generated in preclinical models will be applied in two multi-centre-controlled intervention studies intended to minimize exposure to EDC in children in the perinatal and pre-puberty stages. HYPIEND outcomes will be novel approach methodologies based in in vitro and in silico models, non-invasive biomarkers of HP disruption by EDC and new intervention strategies to minimize EDC exposure in sensitive population.