Report on the activity in the St.Petersburg School of Public Health in the year 2003

 

During 2003 the work in the School progressed along the following lines:

         Finalization of the curriculum and field-testing of it

         Collaboration in the framework of BISPH

         Development of the library of the School

         Training of faculty

         Development of Distance Learning models

         Development of HTA/EBM in the School and Russia

 

Training in the School

During the year 2003 there were following courses organized:

 

 

 

 

 

 

 

Partners

 

N/ Donor

Name of the course

Approximate dates

Duration

Target audience

Number of people

Russian

International

1 MAPS

Good Clinical Practice

March 25-26

12 hours

Postgraduate fellows, research workers, residents

17

Evidence-CPR

 

2 SEEC STAKES

Sociology and Psychology in Public Health

February, 24 -March 7

108 hours

Chief physicians

25

Open Health Institute

University of Chicago (USA), STAKES (Finland), SEEC (Sweden)

3 SEEC

STAKES

Public Health: Economics, Psychology, Prevention

June 5-19

108 hours

Vyborg region chief physicians

28

 

SEEC (Sweden)

4 MAPS

Behavioral sciences and statistics

September 8 - October 4

144 hours

Postgraduate fellows, 2 year

44

 

 

5 OHI

Evidence-Based medicine

October 6,8

12 hours

Faculty, Postgraduate fellows, research workers,

18

 

 

6 MAPS

Introduction to research

October 13-17

36 hours

Postgraduate fellows, 1-year

30

 

 

7 Ott Institute

Evidence-Based medicine and biostotistics

November 10, 12, 17, 19

24 hours

Faculty, Postgraduate fellows, research workers,

17

 

 

8 OHI

Behavioral Sciences in Public Health (in English)

November 24 - December 5

108 hours

Nordic & Baltic BRIMHealth students

15

 

Karolinski Institute, STAKES (Finland), SEEC (Sweden)

9 DFID

Distiance Learning in Family Medicine

November 3-4

12 hours

Faculty

12

 

Royal College of General Practitioners

 

 

 

564 hours

 

206

 

 

 

Total number of students trained - 206

 

In the year 2003 School has completed field-testing curriculum and has started regular training, which is witnessed by more courses supported by MAPS alone and lower usage of foreign trainers. At the end of 2003 all basic courses taught at the school has being implemented, passed through methodological council and approved according to Russian rules and regulations.

The number of foreign lecturers during courses is now on the decline, but still school invited lecturers from the following organizations:

USA

         Chicago University

Sweden

         Karolinska Institute

UK

         Royal College of General Practitioners and University College London

 

The training has been mostly supported by MAPS teachers. Total number of teachers during the courses was 15, 2 of them 4 had MPH, with degrees from Hadassah University School of Public Health. Unfortunately, due to occupation with other international projects two young MPH has been unable to participate in training activities as faculty during whole year.

 

Faculty of the School participated as lecturers on the following training events organized by other organizations:

         Course on Evidence-Based medicine for Family Physicians, Moscow

         Course of Evidence-Based Medicine in Tver

         Summer School of Public Health, Moscow

         Epidemiology and EBM for Health Authority, Tver

         World Bank Conference on HIV/AIDS and Tuberculosis, Moscow

 

Also School participated in the following meetings, providing information on its tasks, activity and plans:

         Seminar of the heads of the departments of public health in medical schools (Maikop, March 2003)

         "Man and Drugs". All-Russia Conference (Moscow, April 2003)

         Standards and Quality in Family Medicine (St.Petrsburg, April 2003)

         INAHTA conference (Canmore, June 2003)

         All-Russia Conference of Rectors and Deans of Postgraduate Medical Institutes and Colleges (October, 2003)

         STAKES conference (Helsinki, October, 2003)

         Meeting of workgroup on creating schools of public health in region of the Baltic Sea (Oslo, October, 2003) -Nordic Dimension Forum

         Meetings of faculty of BISPH (Goteborg, December 2003)

 

Training of faculty

In the year 2003 one more faculty of MAPS returned to work after graduating in October 2002 from Hadassah University Brown School of Public Health in Jerusalem with MPH degree, bringing total number of MPH actively employed by MAPS to 4. Two MPH, graduated in 2001 and 2002 has actively worked at the School organizing seminars and managing everyday activity. They are also used as lecturers and a group leaders during PH courses.

Training abroad:

         One school faculty has spent a month and a half in Norway, researching maternal and child care as a continuation of the project on studying determinants of maternal mortality in St.Petersburg

         Four school faculty has visited Finland to observe activity on HIV prevention among IDUs, prostitutes and adolescents (HIV study tour) in November 2003.

         Two school faculty has took part in TF-sponsored Summer School in Krakow, Poland

         The School Director has been member of Baltic countries delegation that has been studying organization of Public Health training in US (project supported by the US Department of State).

         Head of the HTA laboratory has been on a month long training at SBU (supported by SEEC).

 

All faculty are involved in research work. Among the most important of them are:

         Cardiovascular risk factors and their prevention in Krasnogvardeisky district of St.Petersburg

         Modeling HIV spread in Russia

         Social determinants of mortality

         Prevention of CVD in general practice

         Women's health

 

 

Collaboration in BISPH project

Details of BISPH project, see report of 2002.

During 2003 School has continued to provide training for students from Baltic countries. Already 3 courses read at St.Petersburg SPH are included in the BISPH curriculum: "Evidence-Based Meicine", "Health Management and Economics" and "Behavioral Sciences". Unfortunately with cessation of financing from OSI future of BISPH is unpredictable with possible dissolution of the project.

 

Development of Distance learning project

 

During 2003 School has started to prepare a new distance learning project on control of communicable diseases for PHC professionals (CME courses) and general public. (Task Force PHC 002). The planned duration of the project from April 2003 to April 2004

 

The Goal of the project is to increase access to the information on the modern methods of CCD, especially in remote areas.

 

To reach his goal distance education (DE) package is developed. The package is dedicated to the comprehensive planning of STD/HIV prevention efforts based on understanding politics and sociology of STD epidemics. Course is developing themes raised and discussed in DE-course DProf-01 "Barrier methods of contraception n prevention of STD". (developed in collaboration with Moscow Medical Academy and with expert support from CDC, Atlanta, USA and financial support from OSI). More specifically some questions important for comprehensive planning and interventions, namely, forecast of epidemics development, condoms: production technology, quality control, use, non-compliance and effectiveness, as well as major STD diagnosis and treatment were discussed in depth in DProf-01(total size 246 pages for self-study, ECTS credit hours - 41, ECTS credits equivalents - 2) and not repeated in ongoing project.

In Summer 2003 the project has been presented to the specialists from Open University in UK (world leading provider of open and distance education). They have recommended changes in evaluation structure of the course as previously adopted model was too time-consuming during development phase and allowed less than optimal interaction at the implementation phase. As a result emphasis has been changed in evaluation from exclusively MCQ-based approach to short papers and essay-type evaluation.

Also materials structure has been changed and all materials has been divided into three parts:

         Introductory Readings

         Core Material

         Advanced Reading

Introductory reading contains materials for understanding basic concepts and important things that will follow. It is either not evaluated or evaluated by short papers. Core materials is a main topic of the module. It is evaluated by combination of MCQs and essay. Advanced Reading is an additional information designed to help students understand basic concepts and applications more thoroughly. It is evaluated by means of essays and short papers.

 

 

In preparing the course several approaches has been used in searching for materials for education of PHC specialists in the field of CCD:

A) subject matter experts information on those resources

B) dozens of searches on Internet through Web-based search engines (mostly using Google) and specialized engines (PubMed)

C) Analysis of the content of HIV and STD prevention Web-sites both Russian (low-yeld) and foreign, including site of UNAIDS, CDC, UNDP and others.

D) Analysis of books sold through Internet-bookshops Amazon and Barnes and Noble with subsequent purchase of books (funds from STAKES for supporting the School of Public Health)

E) Analysis of books sold in several large bookshops in Finland and the USA

F) Analysis of periodic literature

 

It is difficult to estimate volume of materials shortly reviewed so we will report only data on relations between amount of materials thoroughly reviewed (read by course developers) - from monographs and amount of it decided to be useful and underwent translation:

 

Total amount reviewed 12525 pages in 32 books. Hours necessary for reading was 1253 or 7 person-months of worktime. Of this amount selected for translation was 842 pages or 7 percent.

 

Amount of information retrieved in Russian language for the use during the course (in printed pages)

 

Core part - 408 pages. Major components of training materials include handbooks on dealing with marinalized popultion (drug users, commercial sex workers), participatory evaluation and using LFA for planning projects (abridged Tempus handbook)

 

Newspaper and magazines clippings (HIV/AIDS, STD and prostitution in mass media) published originally in Russian: 451 pages

 

It is interesting to note relative volume of materials which reflects relevance of original materials on corresponding theme in Russian mass-media. There is almost no publications on STD per se (one out of 51 assessed). One more claimed STD to be major theme, but discussed more STD in commercial sex workers. 13 were dedicated to HIV/AIDS (of them 3 were from foreign press translated by news service inosmi.ru) and 38 to commersial sex work, some of them looking more like brothel/street prostitution guides. This informal rating shows that CSW are center of attention in more than two-thirds of publications, HIV/AIDS in about one-third, whereas conventional STDdoes not grab media attention.

 

Translation of the foreign-language material

 

Total amount of pages translated (at 3500 characters per page - average textbook page) - 433. Equivalent to the 842 printed pages (at 1800 characters per page). Including:

 

L.Garrett. The coming plague, 1994

L.Garrett. The Betrayal of trust, 2000

J.Goudsmit Viral Sex, 1997

S.Watts. Epidemics and History, 1997

A.Karlen. Man and Microbes, 1995

P.Ewlad. Plague Time, 2002

P.Ewald, Evolution of Infectious Diseases, 1994

P.Duisberg, Infectious AIDS, 1995

Cochrane Library , 2001

R.Brookmayer, in Quantitative Evaluation of HIV prevention, 2002

Greenberg, et. al Medical Epidemiology

E. Pisani. Estimating the Size of Populations at Risk for HIV

EMCDDA Estimating the Prevalence of Drug Misuse

H.Schauffler Policy Development

R.Kurz. Quality Assurance and Improvement

T.Rundall. Evaluation.

Baker, Bellis. Human Sperm Competition

Chaulk. The Public Health Paradigm

S.Aral Social Organization of CSW in Moscow

S.Aral Determinants of STD epidemics

Johanna McGeary. Death Stalks A Continent

 

Assessment of the evidences on which aforementioned materials are based

 

Was done by subject matter experts and specialists in evidence-based medicine. Because majority of materials were dedicated to social and political processes it was difficult to employ standard tools of EBM, which was used during discussion of evaluation of intervention effectiveness. Evidence base of "soft" data was checked by triangulation methods (comparing several sources against each other). With exclusion of articles in Russian newspapers triangulation was used for deciding whether to translate parts of the information materials or not. For the former newspaper status and personalities of those mentioned, cited and data sources indication was primary sources of evidence judgement. Some sources were excluded from translation because failing triangulation test.

 

For other periodic sources indication of materials and methods was necessary and several key sources, like Cochrane library was systematically searched for information relevant for the course.

 

1.4 Conversion of the existing Russian-language materials into electronic form

 

Done for some journal articles (i.e. Report from journal "Roundtable" and article on sociology and history of plague from Russian edition of "Scientific American")

 

1.5 Search for the updateable Web-resources on CCD

 

Search for updateable resources identified several Web-sites but majority of them undergo constant changes very seldom, especially if to exclude short news clippings. Most of identified resources were in English, updateable Russian resources included almost exclusively HIV Web-sites. Some of them are Ukrainian sites. Unfortunately, majority of Russian site carried outdated epidemiological data. Presently list of the resources is being prepared.

 

2. Improved methodology of distance learning

 

The following resources for distance learning at the end-user level were analyzed: content delivery by internet with rich multimedia, delivery by internet mostly HTML-based text, WAP-oriented delivery. Also different modes of access were studied: dial-up connections, leased line access, HSCSD mobile access, GPRS mobile access and CSD mobile access. All methods of access are available inside metropolitan St.Petersburg. To test adequacy of WAP access a WAP-site with concise information on STD treatment was set up. It was found that WAP access functioned well with English-language information. The problems with Cyrillic, found previously were solved and additional WAP-site has been created, with Cyrillic support. GPRS and HSCSD performed well under conditions of download of test materials. The download of HTML pages performed well under GPRS and the DE-site has also functioned well.

 

As for content multimedia-rich pages usually had lower added value comparing with essentially paper-equivalent Web-pages which became mainstream of created course.

 

Additional accent has been made in searching for formats allowing download of the course content in compressed form for off-line viewing and reference. Two major formats has been selected: Adobe PDF and iSilo proprietary format. First emerged as format mostly suitable for conserving page layout and good quality illustrations, whereas the second provided high level of compression and was usable on pocket and palm-sized computers. Owing to the high compression rate it is the format suitable for distribution of the content over the internet for offline viewing. Unfortunately, all formats have problems with Cyrillic alphabet. Some need additional proceeding for getting software work under MS Windows (iSilo), some have had problems on palm-sized computers (MobiPocket), some have almost random problems with Cyrillic (PDF) especially when converting from HTML.

 

Report on mobile technologies has been prepared and published on the Web together with data of text formats analysis (http://stphs.narod.ru/Handheld)

 

The pedagogical model underlying distance learning has been extensively studied. Analysis of Russian legislation has been undertaken. Basing on current laws and regulations proposals for introducing credit system at SPb MAPS were formulated and now are under review. Those proposals together with proposal for Ministry of Health could be found (in Russian) at http://stphs.narod.ru/Handheld. Results of the study has been reported on All-Russia Conference of Deans and Rectors of Postgraduate Training Institutes, organized by Ministry of Health.

 

3. Web-site dedicated to general public education

 

Will be developed after completng training site creation as a subset of information completed for DProf-1 and DProf-2. Due to changed timing of financing, resource problems and other questions, financial support of social marketing campaign was not included in final proposal to SIDA and SEEC and so will include mostly submitting data to search engines.

 

Training modules on prevention of STD and emerging communicable diseases

 

The modules are prepared. Development according top-down model with help of Designers Edge software. Background documents prepared, course structure analyzed and agreed. After preparation they should be reviewed by subject matter experts. Passing curricular committee after completing the course.

 

 

Library development

In the year 2003 development of the library progressed along two lines: development of the electronic media library and creation specific, paper-based Public Health library for faculty.

Electronic library of the school is created in collaboration with the Division for Scientific Medical Information at MAPS. In 2003 access to the electronic resources was mostly financed through OSI-sponsored projects and SEEC-supported projects. Most electronic media has been purchased with SEEC funds.

The Division for Scientific Medical Information subscribes to different paper-based and electronic bibliographical sources. Among them

 

Information publications:

"Bulletin of international scientific meetings and conferences" (VINITI)

"All exhibitions"

"Scientific information". Series 1 (VINITI)

"Scientific and technical libraries"

"Informational technologies in health care"

"Informational resources of Russia"

 

Journals:

Bulletin of new medical technologies

Practical physician

New medical journal

Russian medical journal

Scientific and practical aspects of environment protection

Disaster Medicine

New knowledge

BYTE

PC Magazine/RE

PC World/RE

World of Internet

Home Computer

 

Electronic full-text sources are

Ø       Elibrary

Ø       eIFLDIrect (EBSCO)

Ø       Cambridge University Press E-library

Ø       Integrum-Techno

Ø       Cochrane library of systematic reviews

which provide access to the full-text texts of journals published by Kluver Publishing, Springer Verlag, EBSCO, Silver Platter and some other.

 

Detailed description of the databases has been presented in 2001 report (http://stphs.narod.ru/Rep2001.htm#hta)

 

The paper based library from the outset was envision as resource center for faculty and those School students that engage in research projects. In contrast to public library the School library will contain mostly one copy of each book, which will allow to cover wide range of themes with relatively modest funds, taking into account high prices of books, published in English and limited availability of books on Public Health published in Russian.

In the year 2003 School got the books primarily from two sources - STAKES-sponsored purchases and DFID project (development of D-learning).

At present library of the School of Public Health contains about 430 volumes (in 2001 it was about 100 books) roughly classified in the following categories:

         Statistics - 15% (63)

         Basic Epidemiology - 10% (43)

         Infections/STD/HIV - 11% (46)

         Health management - 5% (23)

         Psychology and sociology in public health - 12% (52)

         Evidence-based medicine & pharmacoepidemiology - 7% (29)

         Pedagogic - 6% (25)

         Health & general economics - 4% (18)

         Other

 

Largest donors for the library are STAKES and OSI. Number of books donated by largest donors

STAKES - 34%

OSI - 25%

USAID - 9%

DFID - 8%

SEEC - 4%

Total cost of the books already purchased for the library exceeds 35,000 USD.

The library is successfully used in courses preparation. It planned to grow in 2003.

 

 

Web presence

During 2003 much emphasis was placed on development School Web-site. Formerly it has been used mostly as a place for students to access and download hand-outs and other materials additional to face-to-face training courses. After successful implementation of the first D-learning course in 2002 the transformation of Web-site to repository and a kind of on-line library for PH specialists took place. Supported by financing for development of D-course on STD prevention and on development of HTA/EBM, School started to place on-line translation of materials and redesigned the site for better representation of PH training.

Presently the site consist of :

General information:

speeches of H.Mahler on the opening ceremony of the School of Public Health in St.Petersburg and C.Ortendahl on receiving Honorable Doctor Degree at SPb MAPS

short information on organizations that supported the School

Curriculum

School curriculum

PH curriculum for physician-residents

Information about School courses for this year

School evaluation report (F.-K. Jorgenssen)

After that training materials are presented, separated in five major domains of Public Health, namely: Epidemiology, Biostatistics, Management and Health Economics, Psychology and Sociology in Public Health and Prevention. At present two training modules - 1e (Basics of mathematical epidemiology, about 6 chapters) and 1p (Infectious agent biology and epidemics, about 14 chapters) are placed in free access for self-training. All other materials are considered as a help and self-education by PH specialists, faculty of other Schools and lay persons. The following resources are now placed on site:

Epidemiology

Introduction to epidemiological methods

Estimating the Size of Populations at Risk for HIV

Estimating the Prevalence of Drug Misuse on the Local Level. Capture-Recapture

Two translated epidemiology textbooks (from free access Web-sites):

Coggon et al., Epidemiology for the uninitiated

Dicker et al., An Introduction to Applied Epidemiology and Biostatistics

Hand-outs from epidemiology courses at the School

Biostatistics

Comparison of statistical software programs (selection of articles)

Why we need to use command-line statistical software (selection of articles)

How to select statistical test

Statistical Evaluation of HIV Prevention Programs

Statistical Analysis in SAS (book chapters)

Introduction to Stata

Epidemiological tables in Stata

Hand-outs from statistics courses at the School

Management and Economics

Introduction to strategic planning

Textbook on health economics (from other site)

Textbook on microeconomics (from other site)

Hand-outs from economics and management courses at the School

Sociology and Psychology

Hand-outs from behavioral sciences courses at the School

Prevention

Public Health Policy Development

Quality Assurance and Quality Improvement in Public Health

Preventive Program Evaluation

Other materials include information on EBM/HTA - more than 25 articles and book chapters, short textbook on PubMed search and Women's Health materials (about 20 articles) and pedagogics materials, mostly on distance learning (about 30 articles).

Textbooks are also available for download in on-line Library, presently there are 10 books:

3 on epidemiology (including Abramson's Making sense of data, provided by Tver School of Public Health), 2 on biostatistics (Statistical Decision-making, by S.Plavinski and Econometrical analysis in Stata by S.Kolenikov), 2 on economics, 2 on prevention (STD prevention by Barinova and Raznatovski and Contraception textbook). Also short textbook on PubMed search is placed on-line.

All materials are provided in download-friendly format read by most computer platforms, including palm-sized computers (iSilo or Adobe PDF).

The materials from the site are extensively used for training in Tver School of Public Health (indicated in list of resources), Moscow Medical Academy and Cheljabinsk School of Public Health.

In September 2003 School has joined SpyLOG Web-tracking service to better analyze Inetrent-audience of the School Web-site.

In October-December 2003 there were more than 8300 different visitors to the School Web-site. It has translated in 470 visitors per week and 2700 visitors per month. About 90 persons has visited site more than three times each week, being so-called "core users".

Most visitors were from Moscow (34.3%) 14.3% were from St.Petersburg and about 2% each were from such cities Ekaterinburg, Vladivostok, Novosibirsk, Rostov-on-Don, Tomsk. Slightly less visitors (less than 2%) were from Irkutsk, Nyzhnyi Novgorod, Saamara, Kazan, Perm, Krasnodar, Ufa, Krasnojarsk, Cheljabinsk and Stavropol. This shows, that Web-site is accessible and is used by visitors from almost all large and medium cities of Russia.

Not only Russian visitors are using the site. Russian audience comprise about 76% of all visitors to the site, with Ukraine occupying second place (6.7%). About 2% of visitors were from the USA and 1.9% from Kazachstan and Belorussia each. Also there were visitors from Germany, Latvia, Kyrgisia, Israel, Estonia, Lithuania, Moldova, Georgia, Uzbekistan, Azerbajdzhan, Sweden, UK, France and other European countries, showing that the site is becoming interesting for visitors from different countries, but mostly from NIS, because of majority materials published in Russian.

Most popular search requests that led to the site were:

Decision-making theory

Evidence-Based Medicine

Syphilis

Family Sociology

PubMed

Correlation

Health Economics

Condoms, etc.

If to combine all the request themes, then most of the visitors tried to find STD prevention materials (19.3%), many looked for materials on Biostatistics (18.1%) and EBM (17%). We even has found links to our site in some other forums, discussing condoms types and availability (first course was dedicated to condom use).

Users are usually accessing the site either from work during day-time, or during the evening hours:

Picture show average number of visitors (red line) and pages they looked (blue line) in relation to the time of the day.

The peaks of activity around mid-day (11-13 hours) and evening (about 19) are clearly seen on the picture, showing that we have visitors accessing both from workplace and from home. Only about half of all visitors (31/69) accessed materials during work-time of the School faculty (10 -17), which shows that Web-materials are better suited for majority of intersted in Public Health.

In general, 2003 experience show, that providing training and materials over the Internet is very important new development in the School activity.



 

List of courses, 1999-2003

Courses under School umbrella (usually covering cost of meal and lodging for participants)

Ø       Modern principles of management

Ø       Clinical Management

Ø       Prevention in Health Care

Ø       Family and Public Health (genetic, reproductive & environmental epidemiology and epidemiology of aging)

Ø       Health promotion and disease prevention

Ø       General and clinical epidemiology

Ø       Secondary prevention of STD

Ø       HTA and Evidence-based medicine (English)

Ø       Health management and Economics

Ø       Primary prevention of STD

Ø       Social epidemiology

Ø       Statistics with SAS software in research

Ø       Health management and Economics (English)

Ø       HTA and evidence-based medicine

Ø       Sociology and Psychology in Public Health

Ø       Foundation of Public Health: Economics, Psychology and Prevention

Ø       Behavioral Sciences in Public Health (English)

 

Courses run with MAPS support only (regular, no meal/lodging coverage)

Ø       Introduction to Research

Ø       Statistics for medical researchers

Ø       Public Health Administration

Ø       Evidence-Based Medicine and Health Technology Assessment

 

Brief list of modules prepared 1999-2003

v      Epidemiology

Ø       Basic epidemiology

Ø       Clinical epidemiology

Ø       Special epidemiology (genetic, reproductive, environmental)

Ø       Mathematical epidemiology

v      Biostatistics

Ø       Basic biostatistics

Ø       Introduction to epidemiologal statistical software

Ø       SAS (

v      Evidence-Based medicine and health technology assessment

v      Health economics and management

Ø       Basic economics for health care managers

Ø       Health economics

Ø       Management in health care

v      Prevention and Health promotion

v      Behaviral Sciences in Publci Health (Sociology and Psychology)

v      STD prevention