Report on the activity in the St.Petersburg School of Public Health in the year 2002

During 2002 the work in the School progressed along the following lines:

Training in the School

During the year 2002 there were following courses organized:









N/ Donor

Name of the course

Approximate dates


Target audience

Number of people





Methodology of medical science. Basics of EBM

February 4- March 3

144 hours

Postgraduate fellows, research workers, residents






Health Economics and Management

February, 11 -22

108 hours

Chief physicians


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)




STD prevention II

May 13- 21

72 hours

General Practitioners



STAKES (Finland)




Inequity and Health

June 17-19

27 hours

General practitioners, sociologists, faculty



SEEC (Sweden)




Statistical software. Case of SAS

July 1-5

36 hours







Health Economics and Management (in English)

November 25 - December 6

108 hours

Nordic & Baltic BRIMHealth students


Moscow Medical Academy, OSI, Tver Medical Academy

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





Evidence-Based Medicine and Health Technology Assessment

December 9 - December 20

108 hours

Physicians, faculty


Moscow Medical Academy, Russian Cochrane Center,

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




603 hours





Total number of students trained - 243

Some financial troubles in the beginning of the summer prevented School from completing field-testing of the curriculum (108 course was shortened to 28 hours), the finalization will take place in February, 2002, when first students will complete the training. Apart from this drawback, School has progressed to test and develop curriculum and with exception of the module on behavioral sciences all other modules already 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:




The number of invited teachers from St.Petersburg MAPS was 15, of them 4 had MPH, 3 with degrees from Hadassah University School of Public Health, 1 from Boston School of Public Health. More and more themes are read by young School faculty.

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

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

Traning of faculty

In the year 2002 one faculty of the School started to work after graduating in October 2001 Hadassah University Brown School of Public Health in Jerusalem with MPH degree. She has organized and was manager of the BRIMHealth course on Health Management and Economics. Another graduate just started to work in October 2002, and already has been used as a lecturer and a group leader in the same course.

Postgraduate fellow from Department of Family Medicine underwent training in Finland and now is planning research work based on experience and knowledge he has gained there.

A group of faculty has been on training visits to Norway, learning functioning of health care system there with special attention paid to the prevention of STD.

Several faculty of the School participated in the LFA training seminar, organized by STAKES in St.Pertersburg. Four faculty also took part in the seminar held in Tver in June, 2002.

At present teachers, worked in the School in 2002 has been through the following training (except their Russian MD training and research training)

All of them has been to numerous conferences and workshops held in Sweden, Finland, UK, Germany, Norway and USA.

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

Research projects of newly graduated MPH:

Collaboration in BISPH project

In 2002 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).

To face the challenges of public health, there was a need in the beginning of 1990s for increased competence and capacity in the field of new public health, as there was lack of trained public health specialists in all Eastern European as well as in Baltic countries. With funding from the Nordic Council of Ministers, initial help from WHO/EURO and personal and institutional support from the Baltic Ministers of Health and the Rectors and Deans of the Baltic universities, 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. The BRIMHEALTH program achieved one of its main objectives – to support the development of the national public health training institutions and to train a critical mass of teaching staff. The responsibilities for Public Health training in the Baltic countries have been taken over by national or regional institutions, which collaborate with NHV in the same way as with other international institutions.

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.

According to the ”New Memorandum of Understanding” the BISPH will be governed by the Board consisting of up to two representatives from each country participating in the partnership and a representative from the main financing bodies. The executive body of BISPH is an International Faculty supported by the International Coordinator and Secretariat.

Curriculum of BISPH

The preliminary course program of BISPH was elaborated in 2001, and every partner institution was fully responsible for the planning, organizing and conducting one 2-week course (5 credits for the Diploma and Master of Public Health program of NHV and 7.5 ETC credits):

1) Public Health Science – Kaunas Medical University;

2) Health Promotion – Latvian School of Public Health;

3) Health Ethics and Health and Human Rights – Vilnius University;

4) Health Policy, Planning and Management – University of Tartu;

5) Health Care Management – Medical Academy for Postgraduate Studies in St. Petersburg;

The Intensive Seminar for Master and Doctoral Students (2.5 NHV credits, 3.75 ECT credits) and 30-40 places in various advanced research courses (at 2.5 NHV credits, 3.75 ECT credits) for the BISPH students are annually provided by NHV.

At the present, the BISPH is mainly financed by the Open Society Institute (OSI), a limited financial support is given by the Nordic Council of Ministries (NCM), too. NCM will complete the financing in 2003. OSI will be main financing body of the BISPH until the end of 2003, after that OSI might continue as one of the co-financers of the program.

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.

Though St.Petersburg school is fairly skeptical of the potential impact of BISPH for the development of health care in the region per se, it is a valuable resource for the training of faculty. As a result, School is providing 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". The last course is planned for the year 2003.

Development of Distance learning project

The work on the project has started in October 2001, when first data of needs assessment has been obtained. Those data showed that medical personnel and public health specialists are not very good at knowing the details of condom manufacturing, quality controls and failure rate. Moreover, even the data on condom effectiveness were largely unknown to them. Though first collection of information was unstructured, more in forms of interview and discussions with physicians working at MAPS and students of different courses, the more formal MCQ testing performed in May 2002 showed that sample of physicians attending courses on STD prevention could correctly answer only about 25-30% of the questions regarding condoms testing, production and effectiveness.

Also 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 sources

The first results of the need assessment allowed team to start searching for the materials to be used for the course. Two main sources has been identified:

"The condom monograph" published by Family Health International

"Scientific evidences of condom effectiveness in preventing sexually transmitted diseases" summary of the workshop organized by number of US federal agencies (including FDA and National Institutes of Allergy and Infectious Diseases) in the year 2000

The first source dealt more with condom production, testing, storage, quality control and failures, including consumer-dependent failures. The second analyzed data on condom effectiveness from the evidence-based health care position, trying to estimate real decrease in risk, associate with condom use. Both sources were a good complement to each other.

Both sources (about 200 pages totally) have been translated into Russian and were used for preparing the course materials.

The first analysis of existing materials showed that there is a need for obtaining additional materials specific for Russia dealing with condoms that are sold here, their properties, standards, regulating its production, acceptability, etc. Such information have been found and included in the materials necessary for study. Because of the paucity of the scientific data in this respect, team has been forced to analyze large amount of the data published in popular press. For example, materials on the testing of condoms on sale in Russia have been taken from Penthouse magazine, because no other data was available (analogous data from Consumer Report magazine were dedicated to US market and so are published in English as elective material).

Also during this period the 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.

Also it was necessary to take into account that students of the course will have MD training, and so they would like to have some refreshing information about diagnosis and treatment of common STD. For such students it was decided to have elective part of the course, which is destined for self-control and self-study.

Because one of task for the students will be not only memorize some amount of information, but also be able to find new information on effectiveness to be currently up-to-date. For this reason last part of the course contains information on search in Internet. Because most important information is located not in the open part of Internet, but in specialized data bases like MEDLINE, only introduction in Internet search is provided. More detailed description is provided for the PubMed language, which is search language for the MEDLINE, specifically described are methodological filters that help in a rapid retrieval of important and valid information.

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

Introduction part describes general rules for the course and setting up and using software for off-line knowledge testing - MCQ exam (MS-DOS based software supporting multiple data bases, examination and training modes, support of log-files [encrypted files with results of all starts for a given database with relatively weak Enigma encryption], decoding of the log-file with keyword "-declog", support of encoded database files (also Enigma))

The first part of course consists of three subparts: first describes objectives for the introduction course, second describes epidemiologic situation with STD in St.Petersburg and compares situation with Nordic neighbors. No self-study questions are included in this part of the course, as this information is only for orientation and not needed to be memorized. Third part of the introduction to the needs for prevention (main) is dealing with epidemics forecasting and include materials on sexual behavior, sexual networks and mathematical models in STD epidemiology.

Main part of the course consists also of three main parts: male latex condoms, non-latex condoms and evidence-based assessment of latex condoms effectiveness. The part dealing with male latex condoms describes basics of the condom manufacturing, acceptability of the condoms, condom failure and behavioral reasons for failure. Also it is described how the data from pregnancy studies could be extrapolated to the assessment of condom effectiveness. Separately such issues as latex permeability and latex allergy are addressed. Specific information on condoms used in Russia is provided, together with acceptability information and Russian standards. The evidence basis of latex condoms effectiveness is assessed for the two types of STDs: Discharge STDs (HIV, Gonorrhea, Chlamydiasis and Trichomoniasis) and Ulcerative STD (Herpes, Chancroid, Syphilis and HPV). The data presented in this part of the course are used for forecasting MCQ's

Last part of the course is dealing with search for materials on STD prevention in Internet. Short presentation is dedicated to the use of general search resources, like Google or AltaVista search engines. More detailed description of the PubMed search language is provided with accent on using Boolean operators in search, detailed description of MESH trees and what is MESH termini, shortly other MEDLINE fields are presented. Many reference tables are provided, translation table of the PubMed system is described and methodological filters are presented. The examples of the search results are provided, which could be used as training materials in the main part of the course (search results are presented, of course, in English).

Also a special page with utilities for PubMed search optimization is provided. Project team has downloaded from NLM Web-site MESH dictionary (more than 20 Mb), MESH tree description and Subject Heading description, transformed all databases into TomeRaider format. Before selecting this format study of the formats has been undertaken. The 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 (see comparison table in Appendix 3). Tome Raider allowed fast search of the database with good compression properties. Conversion has created 9.5 Mb file of MESH termini which was compressed by TomeRider to the 4.2 Mb size (47% original size). What is also important that this format is compatible with many handheld and palmheld platforms (EPOC, Palm, PocketPC), not only with Windows. As is stated at the TomeRaider Web-site (, TomeRaider is a fast, flexible and powerful cross-platform reference viewer giving instant and free access to hundreds of megabytes of encyclopedias, dictionaries, guides, religious works, philosophical texts, e-texts and novels in TomeRaider format. TomeRaider is combining the best elements of flat text documents with features of a database such as indexing, fast navigation and searching. In addition compression, rich-text formatting, bookmarks and hyperlinks enhance the TomeRaider further.

By-products of the project and workload calculation

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)
Calculation of the workload so far

1 FTEH = 30 hours workload for preparing the materials (lowest expert estimation - St.Georges Medical School, London). For the course of this size it equals to the 3256 person-hours.

1 MCQ = 10 minutes in preparation + 7 minutes for Web-publishing (own estimation). For the course so far = 37 person-hours

At present all materials are published, some MCQ still to be added, group is formed, materials has been used for training purpose in May 2002, partly will be published in Russian Family Physician Journal as paper supplement to D-learning program.

At present course prepared for 9 weeks distance learning course (complete with elective part), or 108 full-time equivalent-hours (= 3 weeks full-time course)

Number of MCQ so far corresponds to the lower limit for the 3 weeks FTCE (2-5 MCQ per 2 full-time equivalent hours (FTEH) = 108-271 MCQ per course)


Some facts about the course


The original material preparation


Software developed



Prevention of STD

Significant resources of the School has been used in STD education efforts in a form of training the trainers approach. In May, 2002 a ten days course entitled "STD prevention part II" has been organized. During this course family physicians, employees of Centers of prevention and women health clinics were aquatinted with methods of prevention of STD, methodology of discussing sexuality with the patient, work with adolescents, etc. As teachers members of different NGOs working with adolescents and IDUs were employed.

Also a clinical guidelines for diagnosis and treatment of STD by family physicians has been created. It is important to note, that up to now, treatment of STD officially limited to only specialists clinics which are licensed to perform such treatment. Ordinary MD is unable to perform such duty. In this respect guidelines co-authored by chief dermatovenerologists of St.Petersburg are a great leap forward in understanding that STD epidemics should be fought by all available medical manpower.

Also faculty of dermatovenerology department created a small popular book for adolescents entitled "Sex without venereal diseases. 69 questions and answers". This book contains information on prevention of most common STD in St.Petersburg, on condom use and its peculiarities, as well as short information about diseases itself. This book will be distributed among adolescents in St.Petersburg and other cities of North-West region of Russia.

Research in the field of Public Health implications of STD was mostly accented on possible scenarios of HIV spread in St.Petersburg and Russian Federation. Because one of the most important points here is the possibility of full-scale heterosexual epidemics, major attention has been drawn to the study of sexual behavior of IDUs and STD patients. At present about more than 100 IDUs has been interviewed, 97 patients with STD (gonorrhea and syphilis) were also questioned regarding their sexual behavior and practices. A random sample of women has also been screened on presence of chlamydia infection. Preliminary results of the research has been reported during conference on reduction of drug-related harm (Lubljana, Slovenija March 4-8, 2002) and were published in "Russian Family Physician" Journal as well as in monograph "Being Positive" published by STAKES in autumn 2002.

At present new publication based on the results obtained in 2002 is prepared.

It is important to mention that during end of the 2002 the St.Petersburg School of Public Health resumed talks on collaboration in modeling experiments with Imperial College in London, which could result in joint proposal for funding this research.

Another study approach was directed to the adolescent girls. The research has been dedicated to the studying risk factors for STD in adolescent girls, including factors sexual maturity and other biological factors. Some other studies on chlamydia diagnostic are planned.

Library development

In the year 2002 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 2002 access to the electronic resources was mostly financed through OSI-sponsored projects and Norwegian-supported Task Force 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"


Bulletin of new medical technologies

Practical physician

New medical journal

Russian medical journal

Scientific and practical aspects of environment protection

Disaster Medicine

New knowledge


PC Magazine/RE

PC World/RE

World of Internet

Home Computer

Electronic full-text sources are

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 (

The results of activity of work of electronic library are given below:







Full-text (elibrary, eIFLDirect, Cochrane)

Total foreign

Russian Medcine (Russian Medline)


Queries served






Descriptions retrieved/







The usage of full-text services increased heavily in 2002. In 2002 there were 306 queries (comparing with 158 in 2001) totally has been retrieved and delivered to the readers 1499 articles, of them 1304 foreign-language. In comparison, in 2001 there was 800 full-text articles delivered to the end-users.

About 20% of queries has been submitted in informational center with participation of the user.

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 2002 School got the books primarily from two sources - IREX/USAID-sponsored project (ended in 2001 but books has been delivered only in 2002 through Finland) and STAKES. Smaller amounts have been obtained through OSI (OSI sponsored acquisition of vast majority of books in 2001).

At present library of the School of Public Health contains about 300 volumes (in 2001 it was about 100 books) roughly classified in the following categories:

(the percentage could not sum up to 100% because of some books classified as belonging to two categories)

Number of books donated by largest donors

OSI - 35%

STAKES - 22%

USAID - 13%

Total cost of the books already purchased for the library exceeds 24,000 USD.

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

Development of the HTA/EBM training in the School.

Development of HTA/EBM at MAPS is supported very much by grants from SEEC which supports existence of HTA lab at MAPS.

The leading role of the St.Petersburg School of Public health in the field of development of this field has been recognized inside Russia. After first deep course on EBM, organized in framework of BRIMHealth project in December 2001 and first seminars in Gudauri, Georgia, faculty of the School has been asked to serve as lecturers and experts in the field. In March 2002 S.Plavinski has been nominated as expert for Open Society Institute competition for creating evidence-based clinical guidelines. The result of competition has been startling. Though among experts only two were not from Moscow (St.Petersburg and Georgia), out of five grants awarded two went to Medical Academy for Postgraduate Studies in St.Petersburg. Managers of both projects were or are employee of HTA lab at MAPS.

Moreover, Open Society Institute has approached School to organize course on HTA/EBM for members of Russian clinical medicine associations. This course has been organized on December 9-20, 2002 and hosted 57 students from all of Russia (both from European part of Russian Federation and Asia part, including several students from Siberia and Far East). Also 11 teachers taught on those courses, both from St.Petersburg and Moscow. During the course Interregional Society of Evidence-Based Medicine Specialists has been formed with president S.Bashinski (Moscow) and two vice-presidents: V.Vlassov (Moscow) and S.Plavinski (St.Petersburg). This society will create strong ties with Ministry of Health and will promote ideas and practice of EBM and HTA in Russia.

Apart from this course in February 2002 at the department of teaching skills in collaboration with clinical pharmacology institute was organized course on EBM which was for the first time included into approved by MOH training plan.

Faculty from St.Petersburg School of Public Health has been invited as guest lecturers in Georgia in June 2002, to provide short seminars to faculty of Postgraduate Medical Training Academy in Tbilisi, staff and students of pediatric Academy, experts and staff of Ministry of Health of Georgia and Association of Urologists.

Quations of evidence-based approaches were constantly reiterated during all courses run at the School whether it were face-to-face training courses, or distance learning sites. For example, even in the course on using barrier methods of contraception for prevention of STD report on scientific evidences of effectiveness of condoms for STD prevention occupied major part. As obligatory part of the course the mastering of PubMed query language was demanded.

The school has played major role in changes, proposed for the curriculum of medical school students training at the departments of public health - strengthening of the training in epidemiology and introduction concepts of evidence based medicine (Anapa, October 2002).

During 2002 several HTA projects has been implemented (but not finished) - systematic review of effectiveness of different approaches to irritable bowel syndrome treatment; systematic review and meta-analysis of effectiveness of hypotensive therapy (attempt on finding and assessing Russian literature on the subject has been made); rescreening data and reanalysis of effectiveness of hypolipidemic therapy. Also smaller project - systematic review of epidemiologic data on aggression-low cholesterol connection - has been completed.

Web presence

In order to keep updated materials dedicated to the training at the School the Web site of the School at address is constantly updated. In the year 2002 the site has grown and now includes two versions - Russian and English which are partially the same and partially different. English version contains information on school tasks and activity, including translated versions of the programs of schools that has been already implemented and school curriculum. It is also hosting reports of the school activity and materials for English-language courses.

Russian version underwent major update in December 2002 and now includes several parts. The school curriculum is published there, as well as program of training for clinical residents on public health. Also materials for the distance learning parts of the seminars are published there:

Materials for courses on:

Also a special section dedicated to evidence-based medicine has been created, which contains articles by Russian specialists on evidence-based medicine, relevant orders of MOH, information in English, taken from Internet and some other materials.

Fairly developed also section on Distance learning, which contains articles in Russian on technical aspects of distance-learning technologies, overview of gadgets used for mobile learning (m-learning), proposals to MOH regarding draft version of distance learning regulation order, as well as articles in English on - mostly - m-learning, including reports on several field trials.

The short section of additional learning materials has also appeared which hosting translation of H.Mahler speech on the School inauguration, articles by I. Illich and some other information.

Overall size of the site at present is more than 50 Mbytes and expected to grow.

* Decemebr data from 1 till 21 December.

It is important to note, that the site has not been registered with any search systems on the Internet which means that this traffic is supported only by students of the School or their immediate surroundings.

According to the users feedback, the site is a valuable tool for students and contains "wealth of information".

List of courses, 1999-2002

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

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

Brief list of modules prepared 1999-2002