FINAL REPORT ACCORDING TO OBJECTOVE TREE. ST.PETERSBURG SCHOOL OF PUBLIC HEALTH 2001-2003

 

1. GENERALLY ACCEPTED PH TRAINING CONCEPT

1.1 Public health education strategy.

The education strategy for public health in Russia started to change and it is planned that in 2004-2005 finally MPH degree will be officially recognized in Russia. Concept of SPH as a place for training PH-specialists has been repeatedly discussed at the level of Ministry of Health and was supported during Collegium of Ministry in Winter 2002. After visit to the US Schools of Public Health and discussions Workgroup on education in Public health around Baltic Sea agreed to start work on standardization of training programs with five major PH areas crucial for training: epidemiology, biostatistics, management and health administration, behavioral sciences and prevention, environmental health. St.Petersburg SPH has included all those disciplines in the curriculum and this is significantly different from PH training in the past.

St.Petersburg School was also invited and played important role in creating new PH curriculum for medical schools in Russian Federation (project finalized 2003).

 

1.2 New concept and organization of the School inside MAPS

School of Public Health has organizational independence still heavily depending on MAPS. Presently relations between SPH and MAPS are more of traditional College and University relations than the customary Russian relation between Academy and its Colleges. Though Academy is still main employer for faculty and owner of buildings and infrastructure, School is given freedom in selecting faculty for conducting training (with compensation), freedom of creating curriculum (with only final approval by MAPS Methodological Council selecting themes for training. School also possess own operational budget which is different from usual system of subaccounts for MAPS colleges and departments. School Director is at the same time Dean of the MAPS College of Public Health. The overall structure consist of Executive Director (and Board of Trustees), financial department and course managers who are employed for organizing and running the courses.

1.3 Curriculum

The curriculum for the School has been developed in 2000, its testing started in Winter School of 2001. Major amendment was made in 2002 (incorporation of STD prevention modules) and smaller amendments in 2003. All core modules has been tested at least once by March 2003.

 

1.4 New certificate system

Certificate system is heavily depends on decisions of Russian Government. Due to this fact and after detailed analysis of existing approved training programs it was decided that use of existing system will be more appropriate. All students are issued MAPS certificates of completion the course. All students are entered into database holding information on courses passed and number of hours trained. This will form a basis for credit system. First students got School certificate of basic training completion in December 2003.

 

1.5 Staff for PH training

During last three years three persons graduated from Hadassah University Brown School of Public Health with MPH degree and are used as junior faculty at the school. One person graduated from Boston School of Public Health MPH-program. Five persons were on a long-time non-certificate training in Sweden (more than one month duration. 2 persons were on monthly training in Finland. Also numerous short-term training has been organized for School faculty, mostly in Finland (CINDI Winter School, North Karelia visitors program, HIV prevention, etc.) but also in Sweden (Nordic School training course, PH education in Sweden, STD prevention), Norway (STD prevention) and the US (D-learning in PH, PH training organization). Informal evaluation show more profound effect of short-term training on school activityb than MPH-level courses. In general, MPH-level courses were good for forming future faculty of the school but, judging by students feedback, less important for ongoing school operation due to short or non-existent pedagogical experience of MPH. Also some of them has been diverted to work for different international agencies or left country. Out of 6 persons trained as MPH abroad, one left MAPS to work for TACIS and then WHO, second emigrated to the UK. Of four left two are actively participated in training during 2003 whereas two were more involved in other projects.

Short-term training for established faculty was more fruitful in terms of involving people in SPH training. Out of core faculty involved in majority of courses (about 10 persons), all has been trained on short courses abroad, only two outside of the current project. Also visits of MAPS faculty is influencing work of their departmentsb even if the department not constantly involved in School activity (for example, departemnts of Dermatovenerology, Adolescent Health)

1.6 Improved physical facilities

Physcial facilities were improved with help of MAPS funds. During 2000-2003 training took place in filial number 2 located far north of the city. This was due to MAPS hostel location. In 2003 filial number 1 has benn restored, where a new hostel has been opened. Now it is possible to conduct training in place where all informational resources of the school are located (computer class, E-library, paper-based library and HTA laboratory). At present, according to the agreement with MAPS School has access to 40-seats conference-hall, three 15-seats training rooms, three administrative rooms (director, HTA-lab), computer class (8 computers), computer library (5 computers) and 86-beds hostel. If needed, School can use other MAPS facilities including 300-seats conference hall (used during second summer school), 50-seats international conference hall (used for Schools in 2001-2003), 30-seats training room of Family Medicine Department (recently restored, used for LFA training course) and another 25-seats training room (used for STD courses) and others. In general, physical facilities are not a problem for the School at present, owing its tight connections with MAPS.

The sponsor money were used extensively for purchasing presentation and training equipment for the facilities. OSI has sponsored purchase of 4 computers for E-library and provision of Internet access (with match from MAPS). Finnish funds were used for purchase computer equipment including portable equipment for lecture delivery (notebooks and palm-sized computers, helping provide quality training outside of MAPS main base). Swedish funds were used for purchasing LCD projector and additional computer for E-library. DFID funds were used for overhead projector and some other presentation equipment. Totally funds from four agencies were used to purchase equipment that is now used for School activity - USAID, DFID, OSI and SEEC/STAKES. 17 computers were purchased from 1998 to 2003 and several pieces of other presentation equipment (LCD projectors, camcorders for training video footage and other projection devices). Of this amount 30% of computer equipment has been purchased with SweFi support, and 22% of presentation equipment. The possibility to purchase equipment was very important as Ministry of Health is capable to provide money for faculty salary and cover room costs but is not providing money for purchasing small presentation and computer equipment.

During this period MAPS with help of SwiFin financing has set up Internet access by leased line for main building and filial number 1, where E-library is located.

The physical facilities now are much better that were at the beginning of the project and they are better equipped.

 

2. Substance content identified, analysed and improved

2.1 Detailed plans for PH Education.

Curriculum developed, field-tested and all programs are passed through Methodological Council of the College of Public Health (Currcicular Committee). Last program has been passed in January, 2003.

 

2.2 Support to training and courses provided.

 

Totally in 2001-2003 21 course has been organized. They are presented in table below.

 

 

 

 

 

 

 

Partners

 

N/ Donor

Name of the course

Approximate dates

Duration

Target audience

Number of people

Russian

International

2001

 

 

 

 

 

 

 

1 SEEC STAKES

Family in public health

February 19 - March 2

108 hours

Family physicians, PH specialists

50

 

National Public Health Institute (Finland)

Finnish Centre for Health Promotion (Finalnd)

Karolinski Institute (Sweden)

SEEC (Sweden)

Hadassah University (Israel)

2 OSI

STAKES

Health promotion and Disease prevention

May 14 25

108 hours

PH specialists, physicians, general practitioners

33

Moscow Institute for preventive Medicne

University of Tampere (Finalnd)

SEEC (Sweden)

STAKES (Finland)

3 SEEC

STAKES

Epidemiological basis of the Public Health

June 18 29

108 hours

Postgraduate fellows, research workers, residents, PH specialists

49

Socmedeconominform (Moscow)

University of Tulane (USA), SBU (Sweden),

Karolinski Institute (Sweden), the Hospital District of Helsinki and Uusimaa (Finland), STAKES (Finland), SEEC (Sweden)

4 Task Force, STAKES, SEEC

Prevention of STD in general practice.

Part I

October 29- December 2

36 hours

PH specialists, general practitioners

21

Institute of Sociology (Petersburg)

Unit of Skin and Venereal Diseases (Petersburg)

National Public Health Institute (Finland)

Stockholm County Government (Sweden)

5 OSI

SEEC

Evidence-based medcine and health technology assessment

November 26 - December 7

108 hours

Nordic & Baltic BRIMHealth students

15

Evidence-CPR,

Moscow Medical Academy

Duodecum (Finland)

SBU (Sweden)

Karolinska Institute (Sweden)

 

2002

 

 

 

 

 

 

 

1 MAPS

Methodology of medical science. Basics of EBM

February 4- March 3

144 hours

Postgraduate fellows, research workers, residents

11

Evidence-CPR

 

2 SEEC STAKES

Health Economics and Management

February, 11 -22

108 hours

Chief physicians

63

Moscow Medical Academy

University of Tulane (USA), SBU (Sweden), National Board of Health & Welfare (Sweden), Karolinski Institute, University of Tampere (Finland), STAKES (Finland), SEEC (Sweden)

3 STAKES

Norway

STD prevention II

May 13- 21

72 hours

General Practitioners

17

-

STAKES (Finland)

4 SEEC

STAKES

Inequity and Health

June 17-19

27 hours

General practitioners, sociologists, faculty

60

 

SEEC (Sweden)

5 STAKES

SEEC

Statistical software. Case of SAS

July 1-5

36 hours

Faculty

12

 

 

6 OSI

Health Economics and Management (in English)

November 25 - December 6

108 hours

Nordic & Baltic BRIMHealth students

20

Moscow Medical Academy, OSI, Tver Medical Academy

University of Tulane (USA), Karolinski Institute, University of Tampere (Finland), STAKES (Finland), SEEC (Sweden)

7 OSI

STAKES

SEEC

Evidence-Based Medicine and Health Technology Assessment

December 9 - December 20

108 hours

Physicians, faculty

60

Moscow Medical Academy, Russian Cochrane Center,

SBU (Sweden), Karolinska Institute (Sweden), Evidence-CPR (USA-Russia)

2003

 

 

 

 

 

 

 

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

 

 

 

 

As is seen from the table, the number of training hours was fairly stable during those years

         2001 468 hours - 5 courses

         2002 603 hours - 7 courses

         2003 564 hours - 9 courses

but the number of courses rose, which mean that average length of the course declined and number of students per course also declined (see table below)

 

hours

students

courses

av.hours

av.course

468

168

5

94

34

603

243

7

86

35

564

206

9

63

23

 

The first years of activity showed that there is significant interest in PH training, especially in fields of clinical epidemiology with biostatistics (commonly known as evidence-based medicine) and prevention. But people interested in training are usually working and for them it is very difficult to leave working place for a long period of time. Because of this School administration decided to cut length of training and increase investments in Distance Learning.

 

The courses ran by the School in 2000-2003 could be roughly divided into following groups:

Introduction to PH

Ø       Foundation of Public Health: Economics, Psychology and Prevention

Ø       Introduction to Research (Regular MAPS course)

Management and Economics

Ø       Health management and Economics

Ø       Health management and Economics (English)

Ø       Public Health Administration

Ø       Modern principles of management

Ø       Clinical Management

Epidemiology

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

Ø       General and clinical epidemiology

Ø       HTA and Evidence-based medicine (English)

Ø       HTA and evidence-based medicine

Ø       Evidence-Based Medicine and Health Technology Assessment (Regular MAPS course)

Ø       Social epidemiology

Biostatistics

Ø       Statistics with SAS software in research

Ø       Statistics for medical researchers (Regular MAPS course)

Prevention

Ø       Prevention in Health Care

Ø       Health promotion and disease prevention

Ø       Primary prevention of STD

Ø       Secondary prevention of STD

Behavioral Sciences

Ø       Sociology and Psychology in Public Health

Ø       Behavioral Sciences in Public Health (English)

 

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 epidemiological 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      Behavioral Sciences in Public Health (Sociology and Psychology)

v      STD prevention

 

As seen from this data courses were developed and tested with positive feedback from students and large number of students trained (617 participants in 2001-2003).

 

3. Improved pedagogical resources and methodology

3.1 New pedagogical models in place

All courses are using group works, foreign teachers, especially on the first schools has demonstrated many methods that are used now by Russian faculty, including buzz groups, "press-conference" training and fishbowl (courses on health economics and management). Supervision is actively used in training. Balint groups were repeatedly demonstrated (behavioral sciences courses). Together with partners from UK several training seminars were organized dedicated to modern teaching methods. The Department of Teaching Skills is running courses on pedagogical methodology, including workshops on Instruction System Design, Distance Learning, Learning by Questionning, Problem-Based Learning, etc. Many of those models are used at MAPS and in SPH, though many of them still on small scale.

 

3.2 Training of trainers courses

There were two types of courses for trainers. One type were training courses abroad in which only limited number of faculty participated and the second were courses for faculty of the School and MAPS organized in St.Petersburg. Among first group of courses it would be necessary to mention the following:

 

Problem-Based Learning (University of Linkoping,Sweden; Helsinki University, Finland) 2000

E-learning (CDC, Atlanta) 2001

Implementing EBM and HTA (Helsinki, 2003)

Open and Distance Education (Open University, UK) 2003

 

Also faculty of the School took place in many other courses and seminars, among them

         North Karelia Project Visitors Program (Finland, 2000)

         Searching for an Evidence Base for Health Promotion (Finland, 2000)

         3rd Nordic Health Promotion Research Conference (Finland, 2000)

         ASPHER conference (Aarhus, 2000)

         INAHTA conference (Hague, 2000)

         Round Table of the Russian public health schools (Moscow, 2000)

         Seminar in Kellokoski (Finland, 2000)

         CINDI Winter School (Finland, 2001)

         The WONCA conference (Finland, 2001)

         Course on research of local health policy and health promotion (Finland, 2001)

         Summer School on Public Health (Cheljabinsk, 2001)

         The Seventh International Congress of Behavioural Medicine (Finland, 2002)

         Development of PH training in NIS (Jerusalem, 2002)

         First International and Baltic Course on Women, Work, and Health (Latvia, 2002)

         The 2002 Conference of the European Society of General Practice /Family Medicine - WONCA Region Europe (London, 2002)

         Summer School on Public Health (Tver, 2002)

         Logical Framework Project Planning Course (St.Petersburg, 2002)

         INAHTA conference (Canmore, 2003)

         Summer School on Public Health (Moscow, 2003)

         Advocacy in Public Health (Tbilisi, 2003)

         ASPHER conference (Granada, 2003)

 

Some courses were organized at MAPS and faculty has been trained on them. Out of persons most actively participating in the training (having more than 288 credit-hours) 45% were young school faculty. One course was organized specially for faculty of the school (Statistics summer course, 2002). All faculty of MAPS obliged to train at courses on teaching methodology, delivered by Department of Teaching Skills, which chair is Executive Director of the School.

 

3.3 Distance Learning system in place

 

The development of distance education started in 2001. Prior to each course, material related to the course were published on the website of the school. The first study materials were uploaded on the website before the Winter School in 2001. The materials dealt with family psychology, a childs development, violence against women, environmental epidemiology and public health methods. An enquiry among the students showed that many of them had got the material and read it before the course.

As a part of the advanced course in Health Promotion in May, a comprehensive set of material was given to the students on the website of the school. The material consisted of Russian translations of British Medical Journal articles on prevention, a number of Russian articles and abstracts on the same topic, as well as a large article on the public health reform. In 2001 the development of distant learning also involved a study on content mediation on the Internet (text formats, recording of lectures etc.) by IREX/USAID funding. Our project has also contributed to getting modern information technology equipment for the school.

 

2002 witnessed creation and testing of the first distance education course "Role of barrier contraception methods in STD/HIV prevention". The work on the project has started in October 2001, when first data of needs assessment has been obtained. A subject matter expert groups has been formed (including chief dermatovenerologist of St.Petersburg, Director of largest youth STD prevention clinics (Youth health center), general practitioners, etc.). Three meetings has been organized in November 2001 - February 2002. Course material has been selected and translated (about 200 pages). Also collection of illustrative material for the site has been made (graphs, original photos of commercial sex workers in St.Petersburg, etc.)

The discussions of the structure of the course lead team to believe that participants should not be persuaded that STD are serious problem for the public health in Russia, but they need to have data to persuade others and they need to have tools for rough forecasting of the epidemic situation. Correspondingly the basics of mathematical epidemiology have to be included in the training curriculum. The data that are needed for the epidemics forecasting are existing situation with STD and sexual behavior data. The data on STD incidence for the last 10 years has been collected from Bureau of Medical Statistics of St.Petersburg and from project EpiNorth database. The data were collected in such a way that allowed comparison with other regions of North-West of Russia and Nordic neighbors. The data on sexual behavior has been taken mostly from Russia Longitudinal Monitoring Study (RLMS) and additionally results of survey of sexual behavior made by MAPS researchers were introduced into presentation dedicated to the role of sexual networks in STD spread. Additional information that describes behavior of risk group (commercial sex workers and students) has been found and included in materials for study.Detailed description of application of principles of mathematical epidemiology for STD forecasting is presented as separate part of the course completed with Excel worksheet for modeling experiments.

Course structure

Correspondingly at present course consists of five basic parts (detailed description of the course structure is in Appendix)

I. Introduction

II. Introduction into the needs for prevention

III. Barrier methods for prevention

IV. Signs, symptoms and treatment of STDs (elective)

V. Information on STD prevention in Internet

By-product of the project: methodology of workload estimation for D-learning courses, basing on the experience changes to the Ministry of Health order on D-learning has been proposed (August 2002)

 

Some facts about the course

         Total size of the site - 22 MB (with exclusion of the MESH dictionary downloadable files), number of files - more than 1,000

         Number of pages with information (equivalent to printed pages) - 1085

         Number of pictures/graphs/illustrations - more than 170

         Number of MCQ tests created for the project - 157

 

Software developed

         MS-DOS based program for the off-line knowledge testing

         VB Script based applets for on-line examination after compulsory modules

         JavaScript-based pages for on-line self-assessment during study

         Excel worksheet demonstrating approaches to the modeling epidemic spread

 

2003

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 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 mentioned above. 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.

 

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. 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).

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 marginalized population (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

 

The analysis of technological aspects of DE has been continued in 2003. 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.

At present the School has two modules for Distance Learning up and running. One course is completed and another one will be completed in first quarter of 2004. More courses are planned and material is collected for them.

 

4. Functioning Information systems

4.1 Functioning information center

The center has been organized in 2000 based on Center for Scientific Medical Information. Computer class has been set up, equipped (with help of OSI funds), and Internet connection has been established (in 2001, MAPS funds and SEEC financing). In 2002-2003 access to the electronic resources was mostly financed through OSI-sponsored projects and SEEC-supported projects with support (in 2002) through Task Force projects. Most electronic media has been purchased with SEEC funds. STAKES funds are used for purchasing some of the equipment.

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

Elibrary

eIFLDIrect (EBSCO)

Cambridge University Press E-library

Integrum-Techno

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.

 

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.

 

 

4.3 Develop and support production of learning materials

4.3.1 Books

With project support two books has been prepared:

S.L.Plavinski Statistical Decision-making

S.L.Plavinski Short textbook of meta-analysis

Guidelines for Preventing STD in General Practice/ ed. By O.Kuznetsova

K.Raznatovsky, A.Barinova Sex without venereal diseases

Medical Postgraduate Training/ ed by N.A.Beljakov (chapters on Distance Learning)

Presently in preparation:

book on statistical analysis

book on health economics, management and training in health care

 

4.3.2 Publications

Many publications were prepared with partial or full support from the project by the following School faculty: O. Kuznetsova, S.Plavinski, E,Frolova, T.Dubikaitis, E.Rekushevskaya, N.Gurina, A.Barinova, I.Moiseeva, et others. In 2003 S.Plavinski with co-authors published article in BMJ on social determinants of mortality in Russia.

 

4.4 Dissemination methods developed and functioning

Starting from 2003 accents in production of learning materials has been transferred to Web-based materials. 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). Totally site holds translation of more than 100 different articles and book chapters on different aspects of Public Health.

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.

 

5. Improved international relationships

5.1 Exchange programs functioning

5.2 Networks with international institutes established

 

In 2000-2003 the School of public Health in St.Petersburg has been active participant of the project on development of Baltic International School of Public Health, issuing MPH degree according to the ASPHER standards. This project is a legacy of BRIMHealth project, but with less leading role from the Nordic School of Public Health in Goteborg, Sweden (NHV).

The BRIMHEALTH Program (Baltic Rim Partnership for Public Health) was started in 1993 involving Estonia, Latvia, and Lithuania. Poland and the area of St. Petersburg joined the program in 1996. Within the framework of the BRIMHEALTH program during 1993-1995 the first cohort of Baltic students public health trainers and key decision makers were trained in the Nordic School of Public Health, introducing the principles and ideas of the new public health in theory and practice. Since 1995 more of the training was run in the Baltic countries as knowledge, competence and resources were growing there.

 

Development of BISPH

In 2000 the preparatory work to establish the Baltic International School of Public Health (BISPH) started. The plan was approved as New Memorandum of Understanding and is now signed by the partner institutions from Estonia, Latvia and Lithuania as well as the Ministries of Health of the Baltic States.

 

According to the New Memorandum of Understanding the present founder institutions of the BISPH are Kaunas Medical University, Vilnius University/ Centre of Social Medicine, Tartu University/ Department of Public Health, Latvian School of Public Health, The Medical Academy for Postgraduate Studies St. Petersburg and the Nordic School of Public Health. The New Memorandum of Understanding makes provision for the admission of new members, too. By a letter dated August 27, 2001, the Jagellonian University in Poland has expressed its interest to join the collaboration in 2002.

 

The working language of BISPH is English, which has the makings of the international network for public health training around the Baltic Sea. An example of the successful international network is the exchange of students between the BISPH and Nordic School of Public Health, which has been implemented already since 1997 within the framework of the BRIMHEALTH program and will continue in the BISPH as well.

 

Three courses read at St.Petersburg SPH are included in the BISPH curriculum: "Evidence-Based Meicine", "Health Management and Economics" and "Behavioral Sciences".

 

The BISPH financing has ended 2003 and its future unclear, but the same participants are now forming Network of Public Health Schools around Baltic Sea under umbrella of Task Force for Communicable Diseases, last meeting in Oslo has supported idea of joint application to EU funds for continuing collaboration.

 

Apart from BISPH partners, the School of Public Health also has good working relations with the following training institutions:

         Karolinska Institute (Sweden)

         Nordic School of Public Health (Sweden)

         University of Tampere (Finland)

         Hadassah University Brown School of Public Health (Israel)

         Public Health Training Network (USA)

         Technische Universitaet Berlin (Germany)

         University of Leipzig (Germany)

         University College London (UK)

         University of Birmingham (UK)

         Tulane University School of Hygiene and Tropical Medicine (USA)

 

 

6. Research programs operational

6.1 Research on HTA

Systematic reviews performed:

Effectiveness of hypolipidemic therapy (published, 2001)

Low cholesterol and aggression (published, 2002)

High blood pressure treatment (2003)

Antioxidants role in treatment of human diseases and conditions (2003)

HTA research reports:

Analytical Hierarchy Process Incorporating Evidence-Based Effect Measures. Abstr. of the 2001 ISTACH Meeting, - Philadelphia, 2001.- p. 32

Use Of Data On Number Needed To Be Treated (NNT) Derived From Randomized Controlled Trials To Aid Economic Decisions on Treatment// Abstr. of the 2003 ISTACH Meeting, - Canmore, 2003.- p. 8

 

6.2 Research on epidemiology

Cardiovascular epidemiology (STAKES support)

A research project on cardiovascular diseases, stroke, and cancer in the Krasnogvardejskij district, St. Petersburg, was started in 2002, and was continued in 2003. The project was started due to especially high morbidity and mortality rates in the Krasnogvardejskij district caused by the above-mentioned diseases. The partners of the St. P. School of Public Health in this project are the Health Committee of the Krasnogvardejskij district, the St. Petersburg Centre for Statistics, and the St. Petersburg Centre for Health Education. In 2002, surveillance of the risk factors of the mentioned diseases was implemented; 1640 persons were questioned (There are 400,000 inhabitants in the Krasnogvardejskij district.) The results of the screening and questionnaire were analyzed and showed high prevalence of smoking (about 60% males and 26% of females, especially young females among whom about 32% are smoking), arterial hypertension (more than 40% - with about 30% untreated hypertension), high alcohol consumption (in younger age groups 20% and more consumed more than 20 g ethanol/day). More than 40% have had excessive body weight. Patient education materials have been distributed by nurses and physicians who will first were trained at MAPS. The research project and intervention are used as education tools for students of the St. P. School of Public Health.

Publications are in preparation

 

Other projects

Research grants for young scientist awarded in 2002 to Irina Moiseeva to study non-pharmacological treatment of hypertension in general practice.

 

Cardiovascular epidemiology (other support)

Analysis of the causes of increased mortality among Russian males in mid-90s has been made. Some social factors responsible for this are identified. Major publications:

S.L.Plavinski, S.I.Plavinskaya, V.Richter, F.Rassoul, W.Schilow, A.N.Klimov. The total and HDL-cholesterol levels in populations of St.Petersburg (Russia) and Leipzig (Germany) Nutr. Metab.Cardiovasc.Dis.- 1999, v.9, N4, P 184-191

Plavinskya S.I., Klimov A.N., Plavinski S.L. Drop in HDL-C level as possible cause of increased mortality in population. St.Petersburg, Nauka Publishing, 2000, p. 139-140 [in Russian]

Plavinski S.L. Mortality and the lipid levels in Russia in the 90s. Abstr. of the XI Lipid-Meeting Lepzig, - Lepzig, 2001.- p. 43

Plavinski S.L., Merkusheva E.V. The level of blood cholesterol in the population of St.Petersburg. Is there any need for concern? In: Lipoproteinmetabolismus und aterosklerosepravention. Hrsg. von V.Richter, W.Reuter, F.Rassoul, J Thiery - 2002, Verlag Wissenschaftlische Scripten, Zwickau.- S. 365-370

S. L Plavinski, S I Plavinskaya, and A N Klimov. Social factors and increase in mortality in Russia in the 1990s: prospective cohort study//BMJ - 2003; 326: 1240-1242.

S. L Plavinski, S I Plavinskaya, and A N Klimov. Increase in mortality in Russia in the 1990s//BMJ - 2003; 327: 751.

 

Infectious diseases epidemiology

Most of the activity is centered on modelling STD spread, studying risk factors of STD and sexual behaviour. Research support was given through:

Research grants for young scientist awarded in 2001 to Elena Rekushevskaya for her work on STD prevalence in general practice

Research grants for young scientist awarded in 2001 to Viktoria Boeva for her work on risk factors of STD in adolescents

Research grants for young scientist awarded in 2002 to Anna Barinova for her work "Development of diagnostic score for optimizing diagnosis and treatment of genital chlamydia infection".

Some publications:

Plavinski S.L. The Role of HIV infection in the Russian Federation. The role of sexually transmitted diseases (STDs). In: Being Positive. Perspectives on HIV/AIDS in the EU's Northern Dimension and Finland's Neighbouring Areas./ ed by Aaltonen U., Arsalo U., Sinkkonen.- STAKES, 2002.- p. 121-128

Plavinski S.L. Mathematical modelling of STD. Russian Family Physician.- 2002.-N. 1.- . 16-22 [in Russian]

Other publications are in preparation.

6.3 Research on health systems

The study of caost-effectiveness of cardiovascular prevention efforts based on RCT in Pontonnaya village in St.Petersburg has been performed. Results are published:

Frolova E. et al. Effectiveness of CVD prevention. Problems in Health Administration - 2003.- N 3.- 73-82 [in Russian]

Frolova E. et al. Effective correction of cardiovascular risk factors. Economics and Health Administrations 2003 .- N 5 [in Russian]

 

N.Gurina has researched and prepared a report on maternal mortality in St.Petersburg. She analyzed all causes of maternal mortality in St.Petersburg from 1992 to 2001 (148 cases of maternal mortality and 29 cases of fatal accidents with pregnant women). Publication:

Gurina N.A. Causes of maternal mortality in St.Petersburg/ Development of the Schools of Public Health., Tver, 2002. . 70-73. [in Russian]

Other publications are in preparation