REPORT ON THE ACTIVITY OF THE SCHOOL OF PUBLIC HEALTH IN THE YEAR 2001.


During 2001 activity for the development of the St.Petersburg School of Public Health was concentrated mainly along three lines: creation curriculum for the School, providing training for the students of the School and development of health technology assessment training and activity. Auxiliary activity included strengthening of the collaboration with other Schools of Public Health in Russia, training of faculty of the school and participation in research.

Curriculum development

The school curriculum draft version has been completed in February 2001 and was sent to all stakeholders for the discussion. After preliminary approval of the curriculum at the level of MAPS it has also being sent to other School of PH in Russia for comments. During first two quartiles of 2001 no major changes has being introduced into the curriculum. Schools that has being organized in 2001 generally followed curriculum with result that almost all major modules has been presented to the students and after summer course 2002 all major modules will be implemented in the form of core courses (development of deep courses according to the curriculum will take more time). The decision to enter in the summer 2001 programs, supported by the Baltic Sea Task Force on Communicable Disease Control has led to major revision of the curriculum. Additional modules has been included into it and collaboration with more departments of MAPS sought. The main changes has been increase in scope of infectious epidemiology courses. Corresponding module should be reformulated as to incorporate training in sexually transmitted diseases prevention and control, tuberculosis control, infectious diseases surveillance and antibiotics resistance. The implementation of changes in the curriculum is planned for 2002 but modules on STD prevention and control already has been implemented, module on sexual behavior (including high-risk behavior) is in preparation, as well as modules on tuberculosis control (including MDR-TB) and surveillance.

Those changes in curriculum has led to inclusion of more departments in active work at the School. Among them Department of Infectious Diseases, Department of Dermatovenerology, Department of Adolescent Health and Department of Phtysiatry (Tuberculosis). New version of the School curriculum is here

Courses

During 2001 five courses has been organized under the School umbrella. Total number of trainees was 180, total training time is 9 weeks corresponding to the 477 training hours (or 54 School credits), giving 127 student-months. First course in 2001 was Winter School of Public Health named "Family and Public Health". This School has used as lecturers faculty from Russia (MAPS and other institutes of St.Petersburg), Sweden, Finland and Israel. Themes included in the module curriculum were familistic, genetic epidemiology, environmental epidemiology, reproductive epidemiology and nutritional epidemiology. Course has been supported by SEEC and STAKES. Second course was organized in May and it was deep course on prevention. Course was partially supported by the OSI (Soros foundation) and STAKES. It has included themes on different aspects of preventive work - from prevention of cardivascular diseases to workplace and traffic accidents prevention. Students from places outside of North-West Russia (including Moscow, Omsk, Rostov-on-Don and other cities) were present. Lecturers were from Russia (St.Petersburg, Moscow), Finland, United Kingdom, Germany.

Third course was organized in June and was dedicated to the research issues in epidemiology and health systems development. Course was supported by SEEC and STAKES. Partial support for lecturers was (covering airfare) from MASHAV (Israel) and Tulane University School of Hygiene and Public Health (USA). The themes that were included in this module were General epidemiology, survey methods, database creation and analysis, analytical study design in epidemiology, decision analysis and clinical epidemiology. Health systems development included presentation of health systems in Nordic countries, Israel, USA, and Africa. Lecturers were from Russia (St.Petersburg), Finland, Sweden, United Kingdom, Israel, USA.

As a part of activity for promoting ideas of public health in Russia, in October the course for medical journalists has been organized. It was in format of short workshop with invited speakers from Sweden. The workshop has been supported by SEEC.

Next course was organized in October and was dedicated to the prevention of STD in general practice. It was relatively short orientation course which will serve as a start point for increasing knowledge on modern methods of STD forecasting, prevention and control. Lecturers were from Russia, Finland and Sweden. With help of Finnish colleagues contacts with some other institutions (outside health care) in St.Petersburg has been established for this course. The course was supported by SEEC and STAKES.

Last - fifth - course has been organized in November under common umbrella of St.Petersburg School of Public Health and Nordic School of Public Health (BRIMHealth project). It was course on evidence-based medicine and health technology assessment. The course was provided in English for students from Norway, Finland, Lithuania, Latvia, Estonia and Russia. Lecturers for the course were from St.Petersburg, Moscow, Sweden, Finland. The course has been supported by SEEC, OSI, STAKES.

It is important to note that during those courses not only students were trained, but also faculty of the School as well as opportunities for the preparation of a new themes has been used.

Faculty of the School were also invited with lectures to schools and workshops organized by the other Schools in Russia and abroad (Tsheljabinsk, July; Tver, November; Moscow, November; Tbilisi, October).

Faculty training

During 2001 several training programs has been implemented for the faculty or future faculty of the St.Petersburg School of Public Health.

In March - May, two faculty (A.Izotova and V.Savinova) underwent training in epidemiology in Sweden. This training included work in the Swedish Cancer Register, interaction with epidemiology specialists at Karolinska Institutet and was directed to giving trainees information about organization of epidemiological work and research in Nordic Countries, give them first-hand experience in working with general databases and increase their knowledge on organization and implementation of epidemiological research for policy-making. After return from Sweden both trainees has actively participated in the organizing Summer School 2001. Visit was supported by SEEC.

It is important to mention that before visit to Sweden on request from Swedish site faculty underwent short (18-hours) training workshop on using SAS in epidemiology (organized at MAPS).

In August-September one faculty (A.Lebedev) underwent training in epidemiology in Finland. According to the requests from Russian side, the training was focused on organization of epidemiological investigation of quality of care, on using epidemiological data for planning distribution of health care resources. STAKES supported visit.

In December 2001 four faculties of MAPS has visited HIV/AIDS prevention center in Sweden. This visit has been part of general activity on development and inclusion of STD/HIV prevention modules in the School curriculum. Visitors were Head of Dermatovenerology Department, Prof. K.Roznatovsky; Head of Adolescent Medicine Department, Prof. A.Kulikov; Dr. V.Boeva (Adolescent Medicine Department); Dr. A.Barinova (Dermatovenerology Department). Visit has been supported by SEEC

In October 2001 faculty of Department of Family Medicine graduated from Hadassah University Brown School of Public Health (Israel) with MPH degree (one-year International MPH course). This training was supported by OSI. Now four faculty of St.Petersburg School of Public Health have International MPH degrees (three of them from Brown School of Public Health; one from Boston School of Public Health).

Development of Distance Learning

Development of distance learning methodology has been one of the cornerstones of training methodology at the School of Public Health at MAPS. In 2001 it has become reality to put information materials on the Web before course for students to review them in advance.

Due to the problems with XOOM.Com server in USA, it was decided to transfer distance learning materials to the site located in Russia (Narod.ru). Correspondingly, a new Web-site for the School of Public Health has been opened.

First materials that has been published on the Web-site were dedicated to the Winter course and included materials on familistic, environmental epidemiology, articles on HTA and life-saving technology, genetic epidemiology as well as chapters from books on family psychology, sexual development, child development, and violence against women. Interviews with students showed that many of them has accessed and read distance learning materials.

Some lectures has been audiotaped and are available for download from the site upon request to School Administration (they are not openly listed at the site).

Before deep course on prevention training materials also has been published. They included translation of the prevention articles from BMJ, several articles from Russian Journal of Prevention, Abstracts of the articles on prevention (in Russian), as well as article on health care reform (for discussion of how prevention programs fit into it).

Before course on epidemiology glossary has been published, introduction chapter to the book on clinical epidemiology and parts of the books on Meta-analysis and Decision Analysis. After the course handouts were also published on the Web together with materials on statistical data analysis and book on Decision Analysis

Significant amount of activity has been implemented in preparation of the HTA/EBM course. A special part of the server has been dedicated to the information materials for the course. It included suggested reading (review articles and editorials) and materials helping trainees in studying EBM. Those materials included pages with the following content: Introduction to Evidence-Based Medicine (What is Evidence-Based Medicine?, Glossary of terms), How to find evidences? (Educational Prescriptions, Focused clinical questions, Searching for the Best Evidence in Clinical Journals), Assessment (Levels of Evidence and Grades of Recommendations, Study Design), EBM indicators (Likelihood Ratios, NNT, Odds Ratios), SpPins and SnNouts

Two faculty of the School (acting director of the Department of HTA/EBM T.Dubikaitis and S.Plavinski) underwent training on organizing and implementing distance learning system at CDC (Atlanta, USA). This training (called E-learning Institute) was organized as a mean to promote distance training in countries of Central and Eastern Europe. Participants were taught basics of instruction design for D-learning courses, made aquatinted with principles of Web-pages design and work with specific media. All participants were presented with software "Designer's Edge" for implementing plans for D-learning. Also participants were asked to select theme for creating D-learning course that will be supported by OSI foundation (this project will be implemented not through St.Petersburg School of Public Health but through Association of the Schools of Public Health, together with Moscow Medical Academy School of Public Health). Team has selected as theme for the course "Barrier methods of contraception in prevention of STD". This activity is a part of more general D-program on STD prevention implemented under umbrella of Primary Health Care Group of the Baltic Sea States Task Force on Control of Communicable Diseases.

As of November, 2001 team has been informed that financial support for implementation of the program has been granted.

During October-December the following activity has taken place:

Separate activity that has been implemented in this year in developing D-learning is a study of content delivery methods. This work has started in the year 2000 with support of IREX/USAID grant. In the year 2000 different modes of delivery of audiomaterial has been analyzed. It was found that best mode for delivery is DSP format provided by digital voice recorders. Using results of this analysis equipment has been purchased and several lectures taped and published in Internet (if author allowed) or used for training of faculty. Support of STAKES has allowed staff of the School of Public Health to continue work on assessment of content delivery methods - comparison of different modes of electronic media utilization. In 2001 two main areas has been explored: electronic delivery of printed content over narrow-band connection and usability of mobile connections for D-learning content delivery in Russia. First area study consisted in identification available formats for delivery of textual information (at least 13 different formats has been identified and analyzed). The formats included PC-based formats such as MS Word, HTML, RTF, cross-platform formats such as Adobe PDF, specific formats of the handheld and palmheld computers (but available with readers for PC) such as Aportis DOC, iSILO, TCR and TomeRaider, as well as formats of electronic books (Rocket E-book). The formats has been compared as of compression degree (usability for transferring large volumes of information over narrow-band connection) and support of Cyrillic alphabet. Best formats for graphic containing and pure textual formats have been selected. Experiments are planned to be continued with calculation of total time burden for converting Russian-language printed materials into electronic form for delivery over narrow-band connection.

Second area has included exploration of possibilities of modern cellular networks for content delivery. Study of different technological possibilities for data access over GSM networks has been made. Those experiments have started in spring 2001 with utilization of mobile phone access through PDA It was found that CSD connection over GSM network (with peak data throughput about 9,6 kbit/sec) is sufficient for sending and receiving electronic materials of small booklet size (10-100 pages). Also possibilities of WAP-access has been explored (even several Wap-pages with information about School courses has been published). In autumn 2001 St.Petersburg cellular operator NWGSM has started new service - high speed data transfer in GSM network (HSCSD). Experiment with this type of technology showed that it allows access to the much wider types of content, decreasing cost of delivering content. In December 2001 in St.Petersburg new cellular provider - MTS announced future availability of the next generation data access technology - GPRS. If financial situation will allow team will continue study with inclusion of this method and will be able to include data on its utilization in the final report.

All those analyses showed extreme importance of organization of content in highly compressed, ready to be downloaded or easy to be read on mobile devices format. As the result, in planning D-course delivery, it has been decided to implement it in several formats, including - if possible - WAP and text compression methods, not only plain HTML. During 2001 continued the use of Russian Family Physician Journal as content delivery vehicle. After all schools materials has been published there and the journal is widely circulating in Russian Federation. It has even being selected for circulation in FSU countries by the Moscow Bureau of WHO.

Development of HTA/EBM at the School of Public Health

In 2001 development of HTA/EBM in the School has been was centered mostly on getting recognition for this field and providing training and information on this respect. The lectures and training seminars on use of EBM in clinical medicine and HTA in policy making were:

Report of S.Plavinski "Analytical Hierarchy Process Incorporating Evidence-Based Effect Measures " has been accepted as oral presentation at the 17th Annual ISTAHC Conference, but due to lack of financing has not been presented there.

Apart from that material for EBM implementation and critical appraisal of literature has been presented on courses organized by the Department of Teaching Skills in February and December 2001 (in Russian) and on course for General Practitioners in November 2001.

For the next year course on EBM and HTA has been included in the official (approved by Ministry of Health of Russian Federation) plan of courses at MAPS (Department of Teaching Skills).

Also in framework of EBM/HTA development staff of the Department of HTA at MAPS has started the work on full-scale systematic review and meta-analysis that could be used for training purposes. The theme for this meta-analysis has been selected "Whether hypolipidemic therapy prolong life?".

After the search, abstracts of 336 original articles published during the last 26 years in 120 journals, has been analyzed and 78 large studies has been identified which used for treatment different methods from statins to diet. As major outcome measure total mortality has been selected. Analysis was limited to published articles only. The summary analysis used fixed-effect model, statistical analysis performed with help of SAS software (ver. 6.12).This meta-analysis includes also estimation of cost of treatment in Russian and how much each additional life-year will cost for Russian citizen (out-of pocket money)

Two books in Russian - "Introduction to Clinical Decision Analysis" and "Short handbook of meta-analysis" has been published in December 2001.

In September 2001 new acting head for the Department for HTA at MAPS has been appointed (Dr.T.Dubikaitis, MD, MPH). Several candidates for the Department staff are under consideration (including V.Savinova - trained in 2001 in Sweden in general epidemiology). Also general agreement with SBU director, E.Jonsson has been reached that T.Dubikaitis will be trained in SBU next winter (2002).

Department of HTA has been responsible for organization of the BRIMHealth course on EBM and HTA at MAPS in November, 2001 (see above).

During 2001 much efforts has been put into securing access to EBM resources for trainees at the School of Public Health and MAPS. The information center (set up in 2000 with help of OSI funds) was provided with paid subscription for Cochrane library, International Journal of Medical Practice (Russian-language variant of ACP Journal Club). The subscription for the next year (2001) was also paid. Also means from HTA/EBM grant has been used for purchasing special subscription to the E-library and EBSCO. Also search for free Internet resources has been undertaken (and students are provided with bookmarks to corresponding sites, i.e ACP Journal Club, BMJ, NEJM, JAMA, etc.)

At present information center provides access to:

EBSCO full-text database, including

1. Business Source Premier

2. MasterFILE Premier

3. Newspaper Source

4. Clinical Reference Systems

5. Health Source: Consumer Edition

6. USP DI Volume II, Advice for the Patient

7. Business Wire News

8. Academic Search Premier

9. Health Source: Nursing/Academic Edition

E-library

Full-text database of journals from 31 publishing house (1384 journals total, 45593 issues)

Cochrane Library 2001

International Journal of Medical Practice 1996-2000

Russian Medline 1988-2000

MEDLINE (PubMed, with training)

Free Journals on Internet (and limited access journals):

BMJ, Lancet, NEJM, JAMA, AJPH, ACP Journal Club

In Summer 2001 access to the Internet was dramatically improved (from copper phone cable to ISDN line). As the result download speed increased to 7-8 kB/sec and made on-line work in center comfortable. Starting from the fall 2001 Information Center provides free on-line access to the resources for MAPS faculty and School students. In cases help or training is needed specially trained librarians are working there.

Collaboration with other Russian EBM centers. EBM in Russia is not well developed yet. At present centers exist in St.Petersburg and Moscow. Attempts to organize EBM center are also undertaken in Tcheljabinsk. During 2001 contacts with center in Moscow has been strengthened. Director of the Moscow Center for Evidence-Based Practice has been invited to the HTA/EBM course in St.Petersburg. She has meeting with acting director of the Department of HTA/EBM at MAPS. Oral agreement on coordination of activity has been reached. Also agreement on coordinating activity and on use of St.Petersburg experience has been reached with administration of the Association of University Programs, which coordinates activity of Center for Evidence-Based Practice in Moscow.

Staff of the Department of HTA/EBM at MAPS actively participated in development of distance learning materials.

Financing of the Department activity (including financing of HTA/EBM course, purchasing subscription to electronic media, books publishing) has been mostly through SEEC grant, purchases of some equipment have been performed with STAKES financial support.

Other activity

Creation of the Association of the Schools of Public Health

In July 2001 memorandum on creation association of the Schools of Public Health has been signed in Tscheljabinsk. Four Schools became part of this Association. As the first step it was decided to coordinate activity in PH training in Russia, exchange programs and curricula and discuss them as to have in nearest future joint curriculum for all four schools. The second important point of agreement was joint use of faculty. Because number of trained in new PH specialists in Russia is limited, it has been decided to use teachers from other schools in organizing training. Also it was generally agreed that schools with specific expertise will allow faculty from other schools take part in training courses as to implement "training trainers" approach. Examples are agreement with Moscow Medical Academy on possibility of training faculty from St.Petersburg on courses of Management in Health Care; invitation of lecturers from other Schools to Tcheljabinsk, etc.

Research activity

Integral part of PH training is research activity by young faculty. Two projects has been selected this year for support from STAKES - " Risk factors of sexually transmitted diseases (STD) in adolescent girls at different levels of their biological and social maturity " (V.Boeva, Department of Adolescent Medicine) and "Needs assessment and development of the patient education program for family physician and nurses on women's health " (E.Rekushevskaya, Department of Family Medicine). Also a project on study of risk factors and health determinants in Krasnogvardeisky District of St.Petersburg has started. Project on study health determinants and influence of preventive measures on health of people in St.Petersburg has been continued this year at the Department of Family Medicine.

More research activity is planned for the next year, but important task is to increase not only volume but also quality for research - where HTA/EBM laboratory should help with consultation on research design.

Library development

In the 2001 the first books for the library of the School of Public Health has been purchased (OSI funds). Some books have been purchased with STAKES funds and STAKES, SEEC and Nordic School donated some more. Those books already has been used in preparation of the faculty for the seminars and lectures on Summer School 2001, STD course and HTA/EBM course. Materials were also used in preparing revised draft of the curriculum. Unfortunately not all books reserved in March 2001 were brought to MAPS at the end of this year. More books have been purchased from IREX/USAID grant funds but they are also still not arrived to MAPS. Now small School library holds around 100 units of foreign (English-language) books.Next year it is planned to purchase more books and the system of book purchases reimbursement has been discussed with STAKES.

Financial support

In the year 2001 SEEC (Sweden), STAKES (Finland) and OSI have mainly supported activity at the St.Petersburg School of Public Health. IREX/USAID, MASHAV (Israel), University of Tulane School of Hygiene and Tropical Medicine (USA) and University of Leipzig (Germany) have made minor contribution.