Causation and Causal Inference. Measures of Disease Frequency. Measures of Affect and Measures of Association. Types of Epidemiologic Studies. Cohort Studies. Case-Control Studies. Precision and Validity in Epidemiologic Studies. Accuracy Considerations in Study Design. Matching. Field Methods in Epidemiology
SPECIAL QUESTIONS OF EPIDEMIOLOGY
Surveillance. Ecologic Studies. Analysis of Vital Statistics Data. Screening. Clinical Epidemiology. Infectious Disease Epidemiology. Reproductive Epidemiology. Genetic Epidemiology. Nutritional Epidemiology. Cardiovasucular Diseases. Epidemiology. Cancer Epidemiology. Epidemiology of aging. Pharmacoepidemiology
PREVENTION OF STD
STDs and Public Health. Tools for the control and prevention of STDs. Barrier contraception in STD prevention. Specific STDs.
STATISTICAL ANALYSISApproaches to Statistical Analysis. Fundamentals of Epidemiologic Data Analysis. Introduction to Categorical Statistic . Introduction to Stratified Analysis.Applications of Stratified Analysis Methods.Analysis of Polytomous Exposures and Outcomes. Concepts of Interaction.Basic Methods for Sensitivity Analysis and External Adjustment. Introduction to Regression Models. Epidemiological software. Analysis of missing and poorly standardized data. SAS statistical software
EFFECTIVNESS IN HEALTH CARE
Efeectiveness evaluation. Design and types of evaluation and assessment studies. Planning and administrating evaluation. Data collection. Quality assessment
MEDICAL ECOLOGY AND OCCUPATIONAL HEALTH
Environmental protection legislation. Environmental Epidemiology. Medical ecology. Environmental toxicology. Hospital epidemiology. Environment and Health. Occupational health. Rural health and agricultural medicine
HEALTH TECHNOLOGY ASSESSMENT AND EVIDENCE-BASED MEDICINE
Meta-analysis. Information Search and Retrival. Health technology assessment. Clinical Decision Analysis. Scientific writing
Health promotion program. The Strategy of Preventive Medicine
MEDICAL PSYCHOLOGY AND SOCIOLOGY
Theoretical questions of medical psychology. Methods of psychodiagnostics. Psychological basis of psychotherapy. Methods of psychotherapy. Training. Psychology and health care. Psychometry.Medical sociology. Life cycle. Family sociology. Family sexual health. Family violence. Social gerontology. Medical ethics
OTHER QUESTIONS OF PUBLIC HEALTH
Clinical management. Modern Principles of Management in Health Care
GENERAL QUESTIONS OF HEALTH CARE MANAGEMENT
Planning and management in health care. Health Care Organization. Staff in health care. Introduction to health economics. Health economics. Evidence-based health care management. Financing of health care. Basics of financial analysis. National Health Care Systems. Leadership. Motivation. Teamwork. Multidisciplinary teams. Strategic Management
The program of the school should address the future needs of public health professionals by offering several curriculum tracks. Either tracks should enable participants to stay well ahead of current population and societal trends, empower them to face the challenges in the public health field, as well as offering basic training in management and leadership. There would be several skill paths including technology-based health assessment skill path, community-based health assessment skill path and health care administration and management skill path.
The technology-based assessment skill path will offer concentration on appropriate technological and statistical information systems utilised in the health care environment. It will also train participants in critical appraisal skills as well as using informational technologies for search and retrieval as well as systematic analysis of data for the needs of health care. This track addresses the needs and interests of those who wish to pursue and enhance a career in the practice of teaching, planning and evaluation, research or consulting. The objectives are:
• To utilise analytical concepts and tools that can effectively profile the health needs and utilisation patterns of selected population;
• To access, understand, apply and implement current public health technology to a variety of health care settings
• To develop skills in utilising demographic systems and evaluative techniques in assessing health care practice variations, identifying disease patterns, designing and implementing health education and preventive medicine programs
• To provide the skills necessary to perform health assessments through the use of desktop information systems, on-line data sources and the Internet
• To learn the methodology of the analysis of incomplete and poorly standardised data
• Provide skills for critical appraisal of literature and secondary data analysis
Community-based health assessment skills path centres on application of an evidece-based approach to decision-making by focusing primarily on strategies and methods for improving outcomes in public health care. This tack addresses the needs and interests of those who wish to pursue or enhance the career in the areas of community organisations, community development health education and promotion, disease prevention and public health policy. The objectives are:
• To provide analytical concepts and tools necessary for problem-solving
• To develop skills that allow the student to identify potential community barriers to improving health
• To develop strategies for creating coalitions, networks and partnerships
• To learn methodology and functionality of planning tools used for strategic health planning
• To develop skills in assessing, planning and evaluating health education and disease prevention programs and public health policies
• To develop skills in applying an evidence-based approach to decision-making using managed care and public health tools, such as quality assurance, quality improvement and outcome assessment and evaluation
• To provide the skills necessary to perform a community diagnosis
The health care administration and management skill path offers concentration on the issues of application of modern management strategies and practice to the everyday work of health care administrators. This track addresses the needs and interests of those who wish to pursue or enhance the career in the areas of health care management, health institutes administration ad public health policy. The objectives are:
• To provide analytical concepts and tools for management decision-making
• To develop skills in leadership and human resources management
• To learn the methodology of financial analysis and legal sate of different health care institutes
• To develop skills in utilising business planning tools, project management and decision-suport systems
• To learn applicability and peculiarities of marketing research strategies and research in health care
The program will consist of three blocks:
compulsory courses, elective courses and a course work. These amount to 250 credits. All the courses are for postgraduate students. The compulsory courses for one track could be viewed as a elective courses for another track
1. Compulsory courses (minimum 100 credits)
General (for all tracks) - 73 credits
Basic of Public Health (30) *
Public Health - 14
Basic Epidemiology - 6
Clinical epidemiology - 2
Public health nutrition - 2
Theory and practice of chronic disease prevention and health promotion - 6
Research seminar - 20 *
Computer skills - 6
Information search and use of libraries (basic) - 2 *
Basics of evidence-based medicine - 3
Advanced epidemiology (minimum 12 other courses transferred to elective studies) *
Epidemiologic methods - 12
Chronic Disease Epidemiology - 12
Social Epidemiology - 5
Occupational epidemiology - 5
Epidemiology and its application - 12
Technology-based health assessment track (minimum 27 credits)
Computational statistics - 12 *
Advanced Biostatistics - 12
Advanced information search and retrieval - 2 *
Desk-top computerised applications in Epidemiology - 6 *
Community-based health assessment track (minimum 12 credits)
Research design and management - 6 *
Modern psychology and health care. Psychometrics - 6 *
Environmental and occupational health assessment - 12
Health promotion and disease prevention (basics) - 6 *
Health care administration and management track (minimum 23 credits)
Modern principles of management - 12
Clinical management - 6
Financial management (basics) - 6
Management and leadership in Social and Health care - (up to 24 credits) *
2. Elective courses (minimum 100 credits)
Electie courses will contain independent reading, seminar and examinations. Majority of those courses will be organised as distance learning system with small number of seminar hours.
Environmental health - up to 24 credits
Ergonomics - 6 *
Exercise medicine - 6
General practice - up to 24
Health care evaluation - 12 *
Health economics advanced - up to 24 credits *
Health promotion - 6 *
Introduction to biostatistics - 5
Methods of scientific thought - 6 *
Medical Sociology and social psychology - up to 24 credits
Meta-analysis in medicine - 6 *
Philosophy of science - 6 *
Planning of Research project - 6 *
Psychosocial factors and health - 12 *
Scientific writing - 6 *
Social pharmacy - 6 *
Health technology assessment - 6 *
Medical decision-making - 6 *
Marketing research in medicine - 6
Epidemiology of infectious disease - 12
Occupational toxicology - 12
Contemporary state of Public Health (up to 24 credits) *
3. Course work - 50 credits
Course work is to be prepared under supervision of a faculty from the main area of interest.
Medical Informatics, Teaching Skills and philosophy, Family medicine, Medical ecology, Management and Public Health, Epidemiology, Clinical and Occupational Toxicology, Nursing, Foreign languages, Sector of medical and scientific literature
One credit is equal to 8 hours of seminars, lectures and/or self-study (or roughly, one day of training - 6 hours of seminars and lectures and 2 hours of self-study).
Credit system will demand creation of the students data base which will contain data on the courses taken and the number of credits obtained by the student. It is not necessary for the student to pursue the track to master's degree. He/she could participate in only few of the seminars of their choice. But if later they will change their mind they will be able to use credits accumulated during previous study.
The training includes already existing courses read at MAPS Departments of the College of Public Health and new courses which will be organised specially for this program (marked by *). These courses will be known as deep courses and will be dedicated to the selected problems standing before public health specialists as well as contemporary problems in public health. It is necessary to mention that many themes of the new courses are already included into the curriculum of the different departments of MAPS but need to be restructured and separated from other themes (for example, research design and planning, scientific writings and meta-analysis in medicine are part of the crash course read at the Department of teaching skills for first/second year postgraduate students, health promotion is read at the department of Family medicine as part of family doctors training etc.). If the workload during the "standard" MAPS course will be equal preset number of credits, then student can obtain credits for further use in the school of public health: if the student attains monthly course on PhD preparation (Dept. of teaching skills) which contains more than 2 weeks of biostatistics, then he/she could claim credits for the PHS course "Introduction to Biostatistics"(6 credits). In the same time, separate course with the title "Introduction to Biostatistics" will be organised for the students of the School of Public Health.
The courses will relay heavily upon distance learning methodology and some of the elective courses could be run almost completely on the distance. The basis for this distance education will be informational centre at MAPS which will provide information access (including on-line library access), serve as intermediate link between faculty and students in case when faculty is not reachable by E-mail.
It is envisioned that organisation of distance learning courses will include distribution of written and/or audio materials. Those materials will also be available through Web-server (we need to organise publishing of audio/video versions of the lectures) or compact disks. Also assignments will be distributed and E-mail of the course co-ordinator will be provided. Students can ask questions through E-mail and submit assignments.
Some of the course material will be distributed through the journal "Russian Family Physician" which will host a special section entitled "Public Health". This section will contain feature articles and test questions. Student can cut out the form with test questions, fill it and mail back to the School of Public Health obtaining the number of credits (ranging from 0.1 to 0.5 credits). Materials from the journal will also be published on the Web and distributed through Fax-on-demand system. Answers also could be sent by E-mail and/or fax.
It is necessary to point out that such organisation is more convenient for the students but clearly places higher workload on the faculty.
The other type of the courses will be in-place courses organised by the school faculty outside of the St.Petersburg. According to the demands of the region the School could provide (even international) team of the teachers visiting the region. From the financial point of view such courses are cheaper and more easily organized than visits to St.Petersburg. As such they offer wider coverage for possible students (though they need to be better equipped with mobile presentation techniques - LCD projectors, notebooks, compact overheads, etc.).
Causation and Causal Inference
A General Model of Causation. Concept of Sufficient Cause and Component Causes. Strength of Effects. Interaction Among Causes. Proportion of Disease Due to Specific Causes. Induction Period. Generality of the Model. Philosophy of Scientific Inference. Inductivism. Reductionism. Consensus. Bayesianism. Impossibility of Scientific Proof. Causal Inference in Epidemiology. Testing Competing Epidemiologic Theories. Causal Criteria
Measures of Disease Frequency
Incidence. Time. Incidence Rate. Person-Time. Closed and Open Populations. Steady State . Interpretation of an Incidence Rate. Other hypes of Rates. Incidence Proportions and Survival Proportions. Product-Limit and Exponential Formulas. Product-Limit Formula. Exponential Formula. Applications with Competing Tasks. Relation of Survival Proportion to Average Incidence Time. Summary. Prevalence. Prevalence, Incidence, and Mean Duration. Utility of Prevalence in Etiologic Research. Standardization
Measures of Affect and Measures of Association
Measures of Effect Simple Effect Measures . Attributable Fractions . Estimation of Effects Measures of Association Confounding . A Simple Model for Causation and Confounding. Confounders. Standardized Measures. Prevalence Ratios. Other Measures
Types of Epidemiologic Studies
Experimental Studies. Clinical Trials. Field Trials. Community Intervention and Cluster Randomized Trials. Nonexperimental Studies. Cohort Studies. Case-Control Studies. Prospective Versus Retrospective Studies. Cross-Sectional Studies. Proportional Mortality Studies. Ecologic Studies. Hypothesis Generation Versus Hypothesis Screening
Definition of Cohorts and Exposure Groups. Classifying Person-Time. Chronic Exposures. Nonexposed Time in Exposed Subjects. Categorizing Exposure. Average Intensity. Maximum or Median Intensity. Immortal Person-Time. Postexposure Events Timing of Outcome Events. Expense. Tracing of Subjects. Special-Exposure and General-Population Cohorts
Nested Case-Control Studies. Pseudo-rates and the Odds Ratio. Selection of Cases and Controls. Defining the Source Population. Control Selection. Sources for Control Series. Is Representativeness Important?. Exposure Opportunity. Comparability of Information. Number of Control Groups. Timing of Classification and Diagnosis. Variants of the Case-Control Design Case-Cohort Studies. Cumulative ('Epidemic") Case-Control Studies. Case-Only Studies. Case-Crossover Studies. Two-Stage Sampling. Proportional Mortality Studies. Case-Control Studies with Prevalent Cases. Strengths and Weaknesses of Case-Control Studies.
Precision and Validity in Epidemiologic Studies
Precision (Lack of Random Error) Study Size. Study Efficiency. Validity (Lack of Systematic Error) Internal Validity. Selection Bias. Confounding. Information Bias. Generalizability
Accuracy Considerations in Study Design
Improving Precision Efficiency and Apportionment. Precision and Stratification. Improving Validity Choice of Reference Groups. Avoiding Selection Bias. Source of Information. Information on Disease. Information on Exposure. Information on Confounders. Prevention of Confounding. Randomization. Restriction.
Purpose and Effect of Matching. Matching in Case-Control Studies. Why Case-Control Matching Induces Bias. Matching and Efficiency in Case-Control Studies. Costs of Matching. Benefits of Matching. Overmatching. Overmatching Bias. Matching and Cost Efficiency. Matching to Gain Credibility. Matching on Indicators of Information Quality. Bias Due to Overlapping Matching Categories. Alternative Designs. Matching in Cohort Studies. Matching and Efficiency in Cohort Studies
Field Methods in Epidemiology
Data Collection Instruments Abstracts . Questionnaires. Physical Examinations . Biospecimen Collection . Environmental Samples. Field Operations. Experimental Studies . Cohort Studies. Case-Control Studies. Preparation. Changing Field Methods
SPECIAL QUESTIONS OF EPIDEMIOLOGY
History of Surveillance. Objectives of Surveillance. Descriptive Epidemiology of Health Problems. Links to Services . Links to Research. Evaluation of Interventions. Projections. Education and Policy. Summary Elements of a Surveillance System. Case Definition. Population Under Surveillance. Cycle of Surveillance. Confidentiality. Incentives to Participation. Summary Approaches to Surveillance. Active Versus Passive Surveillance. Notifiable Disease Reporting . Laboratory-Based Surveillance. Volunteer Providers. Registries. Surveys. Information Systems. Sentinel Events. Record Linkages . Summary Analysis, Interpretation, and Presentation of Surveillance Data
Concepts and Rationale Levels of Measurement. Levels of Analysis. Levels of inference. Rationale for Ecologic Studies. Study Designs. Multiple-Group Designs. Time-Trend Designs. Mixed Designs. Effect Estimation. Confounders and Effect Modifiers. Methodologic Problems. Ecologic Bias. Problems of Confounder Control. Within-Group Misclassification. Other Problems. Multilevel Analyses and Designs.
Analysis of Vital Statistics Data
Origins of the Method. Data. Statistical Models. Cohort Effects Model. Age-Period Model. Age-Period-Cohort Model. Models That Incorporate the Effects of a Specific Risk Factor. Examples: Smoking and Lung Cancer
Characteristics of Disease. Mortality in Persons Eligible to Be Screened. Effects of Screening. Single Screen. Multiple Screenings. Characteristics of Screening. Measures of Test Performance. Lead Time and Detectable Preclinical Phase. Predictive Value. Feasibility of Screening. Quantification of Mortality. Reduction Ecologic Studies. Outcome Evaluation. Studies of Determinants of Outcome
Studies of the Natural History of illness. Studies of Diagnostic and Screening Tests. Sensitivity. Specificity. Predictive Value. Bayes theorem. ROC-curves. Studies of Therapy-Randomized Controlled Trials. Selection of Subjects. Selection of the Intervention Measure. Definition of Study End-points. Using Patients as Their Own Controls (Crossover Studies). Studies of Therapy-Nonrandomized Studies. Selected Reading
Infectious Disease Epidemiology
Time Lines of Infection. Transmission Probability. Estimating the Transmission Probability. Secondary Attack Rate. Binomial Models of Transmission Probabilities. Other Binomial Models. Transmission in Small Units Within Larger Communities. Basic Reproductive Number. Simple Insights from Ro. Estimating Ro. Incindence, Ro, and the Case-Fatality Ratio. Ro in Macroparasitic Diseases Incidence Rate as a Function of Prevalence and Contact Rate. Contact Rates and Mixing Patterns. Dynamic Epidemic Process in a Closed Population. Transmission in an Open Population and Dynamic Cohort. Recurrent Infections. Measures of Effect Transmission Probability Ratio. Conditional Versus Unconditional Measures. Exposure and Contact. Efficacy. Study Designs.
General Considerations. Reproductive Life Events. Menstrual Cycle Characteristics. Fertility. Time-to-Pregnancy Studies. Pregnancy Loss. Recognized Loss . Early (Subclinical) Pregnancy Loss. Pregnancy Complications. Birth Weight. Dichotomized Birth Weight. Weight-Specific Mortality . Perinatal Mortality. Relative Birth Weight . Birth Weight. Birth Defects.
From Genes to Public Health. Genetic Technology and the Human Genome Project. . Genetic Epidemiology and Core Public Health Functions. Traditional Epidemiologic Studies. Studies Assessing Unmeasured Genetic Factors. Studies Assessing Measured Genetic Factors. Nontraditional Epidemiologic Studies. Case-Only Studies. Case-Parental Control Studies. Affected Relative-Pair Studies. Epidemiologic Approaches to Family Studies. Familial Aggregation in Case-Control Studies. Linkage Analysis in an Epidemiologic Study
Epidemiologic Studies of Nutritional Exposures. Ecologic Studies. Special Exposure Groups. Migrant Studies and Secular Trends. Case-Control and Cohort Studies. Controlled Trials. Measurement of Diet in Epidemiologic Studies. Nutrients Versus Foods. Dimension of time. General Methods of Dietary Assessment. Methods Based on Food Intake. Validity of Dietary Assessment Methods. Biochemical Indicators of Diet. Choice of Tissues for Analysis. Limitations of Biochemical Indicators. Anthropometry and Measures of Body Composition. Methodologic Issues in Nutritional Epidemiology. Between-Person Variation in Dietary Intake. Implications of Total Energy Intake.
Cardiovasucular Diseases Epidemiology
Natural history of arteriosclerosis. Risk factors. Arteriosclerosis Development in Different Populations. Gender Differences. Clinical trials on arteriosclerosis regression and prevention of arteriosclerosis-related mortality.
Incidence, mortality, survival. Risk factors. Treatment and prevention of most common cancers. Results of treatment in different countries. Principles and methods of cancer registration. Cancer Register.
Epidemiology of aging
Changes in health status in aging society. Functional assessment of older persons. Quality of life assessment and subjective assessment of life quality. Measurement of functional capacity of older adults. Comorbidity. Molecular epidemiology of aging. Biodemography of aging. Longitudinal studies on aging epidemiology
Basic principles underlying pharmacoepidemiology. Clinical trials phase I, II and III. Postmarketing survelliance. Side-effect tracking. Study design and sample size. Ethical issues in drug testing and approval. The use of large databases for research. Drug market analysis according to sale-in and sale-out methodology. Pharmacoeconomics.
PREVENTION OF STD
STDs and Public Health
Introduction. What are STDs? Medical impact of STDs. Review of short-term and long-term complications. Economic impact of STDs. The national impact. The worldwide impact of STDs. HIV as a sexually transmitted disease.
Tools for the control and prevention of STDs
Intervention and control approaches. The theoretical basis for development of STD control strategies. The Anderson-May Reproductive Rate Equation and its use in developing control strategies. Sexual partner mixing patterns. Social sexual networks. Using local and national survey data to assess risk. Behavioral, and vaccine interventions (primary prevention) –overview. The theoretical basis for partner notification, presumptive treatment, and screening interventions. Practical aspects of partner notification. Community STD assessment-cultural and epidemiological issues. STD surveillance. The rationale for STD surveillance. Technical and practical issues related to STD surveillance: prevalent vs. incident diseases, sensitive behaviors, public/private reporting differentials; confidentiality issues. The concept of the STD case definition for surveillance. Passive disease reporting. Potential alternative options for surveillance and disease reporting systems including resistance-monitoring systems. Assessment of disease rates in specific communities. Using population-based data to estimate STD burden. Using geographic mapping systems to localize STD morbidity Sexual behavior principles. Model based approaches of STD interventions Issues related to change to prevention, maintenance, and relapse (prevention failure). Issues related to HIV counseling and testing as a behavioral intervention: Is this a viable intervention, is it cost effective. Issues related to research methods in developing behavioral interventions. Issues related to recall bias, social desirability, and ethnographic issues in developing questions free or to minimize response bias. Sexual behavior interventions: experience and issues in implementation. Evaluation of STD HIV prevention interventions: issues, problems, and approaches. Community-based intervention strategies. Examples and lessons learned: NIMH Multisite Intervention Study. CDC Project Respect. Studies in Thailand (Armed Forces and CSWs). STDs and sexual behavior.Sexually transmitted diseases, drugs, and alcohol. Relationship of substance abuse and STDs: co-existent social issues. Changing drug substance abuse patterns impacting on changes in STD epidemiology. Alcohol as the most common drug effecting STD control issues. Impact of substance use on ability to implement traditional STD interventions. STD, pregnancy and contraception. Principles of vertical transmission. Differentiation between transplacental transmission and perinatal transmission. Adverse outcomes-infection, low birth weight, death (stillborn or fetal demise). Public health principles of preventing adverse perinatal outcomes. Screening issues in the prenatal and perinatal period. Newborn prophylaxis issues Cost effectiveness and STD interventions. Determination of STD Intervention Cost-effectiveness-consideration of short-term and long-term outcomes. STD screening-cost-effectiveness studies-chlamydia as a model. Azthromycin vs. doxycycline treatment for chlamydia, a paradigm of single dose vs. multiple dose treatment. Ethical issues in STD control. STDs and stigma. Confidentiality issues in practice, reporting, and intervention. STD intervention in marginalized and stigmatized populations. Individual and Societal responsibility to sexual partners. Community-Based intervention studies-ethical issues. The Tuskegee study and its legacy
Barrier contraception in STD prevention
STD prevention methods. Male condoms. Female condoms. Vaginal spermicides, sponges and diaphragm. Males latex condoms Pregnancy and STD: Factors that influence pregnancy rates; Effectiveness of latex condoms against diseases; Latex membrane permeability. Acceptability of the condoms: Reasons for non-use; Changing behavior; Product choices (Lubricant, Width, Thickness, Formulation, Shape/texture, Materials). Behavioral basis of condom failure: Definition of condom failure; Groups of people experiencing failure; Physical and demographical characteristics related to condom failure; Behavioral factors of failure. Correct usage of the condoms. Basics of the condom manufacturing: Latex formulation; Standards, specifications and tests (Standard-setting agencies, Laboratory tests: Leakage, Dimensions, Tensile properties, Air-brust test; Deterioration tests); Laboratory tests and human use (Cross-sectional studies; Prospective studies; Other design of the studies). Condom packaging. Dry powders. Latex allergy. Non-latex condoms. Synthetic elastomeric condoms.The female condom. Male natural skin condom. Information on STD prevention in Internet. Search for STD prevention information. MEDLINE search. Guidelines
Gonorrhea. The microbiology of Neisseria Gonorrhoeae. Pathogenesis of gonococcal infections. The mucosal syndromes of gonococcal infection. Diagnosis and treatment of gonorrhea. Antimicrobial resistance: an epidemiologic paradigm of emerging infection, surveillance, and control policy. Chlamydia infections. The epidemiology of chlamydia. The relationship between chlamydia and pelvic inflammatory disease. Diagnostic and treatment strategies for chlamydia, especially changes in diagnosis which have occurred over the past 10 years. The effects of implementation of screening programs on chlamydia prevalence. The role and implementation of public health interventions for Chlamydia. Pelvic inflammatory disease. Impact of sexually transmitted diseases on the female reproductive system. Emphasis on women as the bearers of the bulk of STD morbidity. Pelvic Inflammatory Disease: pathogenesis, development of complications. Pelvic Inflammatory Disease: long-term complications: Tubal factor infertility and ectopic pregnancy. Vaginitis syndromes. Vaginitis syndromes—overview. Trichomonas infection: diagnostic and management principles. Bacterial vaginosis: diagnosis and management. Vaginitis syndromes and their impact on perinatal morbidity: relationship to premature rupture of membranes and adverse perinatal outcomes. Syphilis.The basic biology of Treponema Pallidum infection. The clinical presentations of primary, secondary, and latent syphilis. The epidemiology of syphilis, especially the changed epidemiology of syphilis over the past 20 years. Issues related to syphilis control, and approaches. The interactions of syphilis and HIV infection, including increased transmission of HIV, and altered clinical presentation of syphilis. Herpes Simplex infections. Herpes simplex as a prevalent disease, as opposed to an incident disease. The epidemiology of herpes simplex infections. Diagnostic issues related to herpes, especially differentiation of first clinical episode vs. primary infection. The role of diagnostics in herpes infection, especially culture and serology. Herpes simplex morbidity, especially perinatal infection and its prevention. The development of herpes simplex control strategies. Human papillomavirus infections and cancer. The basic biology of HPV infections, a non-cultivable virus. HPV infection and genital warts. The relationship between HPV infection and cervical cancer, especially HPV subtypes. The epidemiological issues in studying HPV and its disease relationships. The rationale for development of HPV control strategies including appropriate use of diagnostics. HIV STD interactions Epidemiological associations of HIV and STD infections, especially in developing countries and in undeserved areas. Behavioral associations between HIV and STDs. Biological relationships between HIV and STD: facilitation of HIV transmission by sexually transmitted diseases, genital ulcer and exudative disease paradigms. Impact of HIV on the natural history of STDs. Developing control measures for HIV/STD intervention, biological and behavioral approaches.
Approaches to Statistical Analysis
Significance Testing. P-Values. Hypothesis tests. Statistical Estimation. Confidence Intervals and Confidence Limits. Relation of Confidence Intervals to Significance Tests. P-Value Functions. Evidence of Absence of Effect. Guidelines for Practice. Problems With Confidence Intervals. Bayesian Intervals.
Fundamentals of Epidemiologic Data Analysis
Elements of Data Analysis. Data Editing. Data Description and Summarization. Data Tabulation. Choice of Categories. Classification of Subjects and Person-Time. Handling of Missing Values. Methods of Testing and Estimation. Sensitivity and Influence Analysis. Probability Distributions and Exact Statistics. Approximate Statistics: The Score Method. Approximate Statistics: The Wald Method. Likelilhood Functions. Approximate Statistics: The Likelihood-Ratio Method. Likelihoods in Bayesian Analysis. Choice of Test Statistics. Continuity Corrections and Mid-P-Values. Computation and Interpretation of Two-sided P-Values. Multiple Comparisons. Joint Confidence Regions. Problems With Conventional Approaches.
Introduction to Categorical Statistics
Sample-Size Considerations. Independence of Outcomes. Homogeneity Assumptions. Classification of Analysis Methods. Person-Time Data: Large-Sample Methods. Single Study Group. Two Study Groups. Pure Count Data: Large-Sample Methods. Single Study Group: Large-Sample Methods. Two Study Groups: Large-Sample Methods. Relations Among Ratio Measures. Case-Control Data. Case-Cohort Data. Small-Sample Statistics for Person-Time Data. Single Study Group. Two Study Groups. Small-Sample Statistics for Pure Count Data. Single Study Group. Two Study Groups. Application of Exact 2 x 2. Programs to Person-Time Data and Single-Group Data.
Introduction to Stratified Analysis
Effect-Measure Modification Versus Confounding. Assessment of Confounding. Selecting Confounders for Control. Statistical Biases in Variable Selection. Selecting Confounder Categories. Examining Stratum-Speciflc Effect. Estimates Standardization Standardized Differences. Standardized Ratios. Confidence Intervals. Standardized Case-Control Estimates. Assumption of a Uniform Effect. Pooled Estimates Small-Sample Methods. Maximum-Likelihood Estimators. Unconditional Versus Conditional Analysis. Mantel-Haenszel Estimation: Person-Time Data. Mantel-Haenszel Estimation: Pure Count Data. p-Values for the Stratified Null Hypothesis. P-Values for Stratified Person-Time Data. P-Values for Stratified Pure Count Data. Testing Homogeneity. Case-Cohort Data. Two-Stage Data.
Applications of Stratified Analysis Methods
Analysis of Data from Matched Studies. Analysis of Matched-Pair Cohort Data. Analysis of Matched-Pair Case-Control Data. Basic Survival Analysis. Risk Estimation. Estimation of Average Survival Time. Comparison of Rates Over Time. Attributable Fraction Estimation. Analyses of Induction Periods
Analysis of Polytomous Exposures and Outcomes
Categorization of Ordered Variables. Basic Tabular Analysis. Dose-Response and Trend Analysis. Graphing a Trend. Plotting Confidence Limits. Vertical Scaling. Incremental (Slope) Plots. Horizontal Scaling and Category Scores. Smoothing the Graph Trend Statistics. Special Handling of the Zero Lewel. Moving Averages. Variable-Span Smoothers. Categorical Estimates as Moving Averages. More General Smoothers. Basic Analysis of Multiple Outcomes. Simultaneous Statistics For Tabular Data. Joint Confidence Regions. Simultaneous Analysis of Multiple Outcomes. Relation Between Simultaneous and Single Comparisons.
Concepts of Interaction
Statistical Interaction. Effect-Measure Modification. Biologic Interactions. Counterfactuals for Two Variables. Interactions Under the Sufficient Cause Model. Relation Between the Counterfactual and Sufficient Cause Approach to Interactions. Inferences About Biologic interactions. Biologic Versus Statistical Interaction. Statistical Analysis of Biologic Interactions. Public-Health Interactions
Basic Methods for Sensitivity Analysis and External Adjustment
Analyses of Confounding. Analyses of Misclassification. Disease Misclassification. Confounder Misclassification. Misclassificatlon of Multiple Variables. Matrix Correction Method. Use of Validation Substudy. Data Selection Bias. Combined Corrections. Sensitivity Analysis of Statistics.
Introduction to Regression Models
Regression funitions. Frequentist Regression. Other Concepts of Population. Regression and Causation. Binary Regression. Multiple Regression. Regression Measures of Effect. Multivariate Regression. Frequentist Versus Bayesian Regression. Basic Regression Models. Model Specification and Model Fitting. Background Example. Vacuous Models. Constant Models. Linear Risk Models. Recentering. Rescaling. Exponential Risk Models. Logistic Models. Other Risk and Odds Models. Rate Models. Incidence-Time and Hazard Models. Trend Models: Univariate Exposure Transforms. Interpreting Models After Transformation. Multiple Regression Models. Relations Among Multiple-Regression Models. Product Terms (Statistical Interactions).Trends and Product Terms. Interpreting Product-Term Models. Regression Models. Trend Models in Multiple Regression. Categorical Trends. Regression With Category Scores. Power Models. Regression Splines. Models for Trend Variation. Extensions of Logistic Models Polytomous Logistic Models. Ordinal Logistic Models. Generalized Linear Models
Using software for study planning, data collection and analysis. Major statistical software packages: SAS, Statistica, SPSS, STATA, Statgraph and other. Study planning, data input and correction. Simple univariate analysis. Parametrical methods. Nonparametrical methods. Correlation and regression. Multiple regression. Logistic regression. Modelling and analysis of survival. Life tables. Cox proportional hazard model. Differences between software packages. Simulations
Analysis of missing and poorly standardized data
Data mining. Methods of data mining. OLAP. Visual inspection. Classification trees. CHAID, CART, FIRM and other calssification algorithms. Their positive and negative sides. Classification tree software AnswerTree, Statistica. Other packages. Neurona nets. General principles. Multi-layer preceptron. Creation of neuronal network. Training. Visual development systems. Software package NeuroSolutions. Analysis of data. Software package Nevada Prop. Using nuranal nets and classification trees.
SAS statistical software
Data input. DATA step. Merging, appending and dividing datasets. Univariate analysis. Procedures UNIVARIATE and MEANS. Plots. Analysis of quantitative data. PROC FREQ. Group comparison. PROC TTEST. Nonparametric methods. PROC NPAR1WAY. Several groups comparison. PROC ANOVA and GLM. Correlation and regression. PROC CORR and GLM. Survival analysis. PROC LIFETEST, LIFEREG and PHREG. Other methods of analysis. Factor analysis (PROC FACTOR) and multidimensional scaling (PROC MDS). How to create SAS jobs.
EFFECTIVNESS IN HEALTH CARE
Some basic definitions. Assessment object. Evaluation and activity plan. History and theory of evaluation. Four types of evaluation.
Design and types of evaluation and assessment studies
Experimental evaluation. Randomized controlled trials. Postive and negative sides of RCT. Quasi-experimental and observational methods. RCT assessment. Economical evaluation. Cost analysis. Cost-effectiveness. Cost-benefit. Cost-utility. Positive and negative sides of economical evaluation. Development evaluation. Defining development evaluation tasks. Descriptive and activity evaluation. Positive and negative sides of development evaluation. Management evaluataion. Types of management evaluation. Effectiveness measurement. Positive and negative sides of management evaluation.
Planning and administrating evaluation.
Phases of evaluation. Planning and design of evaluation.Analysis of evaluation results. Implementation phase.
Collection of the data for evaluation. Observation. Interviewing. Questionnaires and surveys. Measurement methods. Using existing information sources. Data analysis and interpretation.
Principles of quality assessment. Differences between assessment of quality, results and effectiveness. Methods of quality assessment. Audit, accreditation and analysis of program quality.
MEDICAL ECOLOGY AND OCCUPATIONAL HEALTH
Environmental protection legislation.
Public Health as basis for enivoronmental protection legislation. History of legislation. Federal and local laws. Medical institutions and waste disposal. How legislation influences state of environment.
Domain of Environmental Epidemiology. Exposure Assessment. Overview of Study Designs and Analytic Tools in Environmental Epidemiology. Descriptive Analyses and Uses of Time-Trend and Spatial-Pattern Data. Time-Related Analyses. Mapping. Similarities and Differences Between Time-Trend and Spatial-Data Analyses. Poisson Regression. Special Issues in Time-Series Analyses: Confounding, Autoregression and Intermediate Variables. Special Issues in Spatial Analysis: Confounding and Analysis of Clusters Confounding in Intercommunity Comparisons. Types of Analyses to Assess Spatial Patterns. Cell-Count Methods for Evaluating Clustering. Adjacency Methods.
Distance and Nearest-Neighbor Methods. Analysis of Clustering Around Point Sources. General Considerations in the Investigation of Clusters. Surveillance. Risk Assessment
General questions of medical ecology. Estimation of the effect of biological, physical and chemical hazards. Exposure assessment. Legal regulations for control and suervelliance..
Sources, pathways and effects of toxic substances in environment on humans. Pathophysiology of the action of toxic substances. Pathophysiology of air and water pollutants. Toxic metals. Pesticides. Solvents. Toxic compounds in the food. Other chemical substances.
Hospital infection. Side effects of treatment. Analysis and control. Survelliance. Resistant microorganisms. Molecular epidemiology. Tuberculosis control. Device infections. Latex allergy. Sterilization - use and control.
Environment and Health
Humans and the Ecosystem. Anthropogenic effects on ecosystems. Influence of the ecosystems on humans. Air. National and Global Ambient Air Quality. Air pollution emergencies. Indoor Air Quality. Water. Water Quality Characteristics. Assessment of Water Quality. Drinking Water and Wastewater Treatment. Land Use and Soil Conservation. Risk Assessment and Policy. Risk Perception and Management. Hazardous Wastes.
Occupational medicine. Principles and practices. Industrial hygene and workplace safety. Management of health care in industry. Major groups of occupational diseases. Control comissions. Legal aspects of health protection on workplace.
Rural health and agricultural medicine
Problems of agricultural health care. Diseases of rural areas. Social and economic problems in rural areas, its influence on health and workplace safety. Occupational diseases in agricultural industry. Environmental hazards in rural areas.
HEALTH TECHNOLOGY ASSESSMENT AND EVIDENCE-BASED MEDICINE
Definition of meta-analysis. Two meta-analytical tasks. Different types of meta-analysis. Stages of meta-analysis. Strategies and drawbacks of the methods. Meta-analytical tasks. Selection of variable. Selection of studies. Effect size. Meta-regression. Statistical analysis of individual studies. Determination of effect sizes. Interrelation of different effect size estimates. Correction for confounding. Bias correction. Regression of frequency estimates and odds ratios. Analysis of missing data. Graphical methods in meta-analysis. Forest plot. "Odd man out" approach to meta-analysis. Funnel plot. Method L'Abbe. Statistical methods in meta-analysis. Basic methods. Analysis of qualitative data. Analysis of quantitative data. Subgroup analysis. Analysis of correlation. Fixed-effect models. Random-effect models. Analysis of heterogeneity. Problems in meta-analysis. Aggregation error. Publication bias. Small studies. Some inadequate methods. Vote count. Scatter of test statistics. Quality scales. Role of meta-analysis.RCT-"gold standard" for meta-analysis? Development in meta-analysis. How to analyze meta-analytical articles.
Information search and retrieval
Types of information. Information search on new and known theme. Methods of screening appraisal of monographs and textbooks. "Closed cycle" approach. Science Citation index. Referative journals. Excepta Medica. Bibliographical databases. MEDLINE. Structure of database. Access systems - PubMed and Internet Grateful Med. How entries are indexed. MESH thesaurus. Search language. Complex search strategies. High sensitivity and high specificity search. System limitations. Russian medicine. Search language. Search strategies Other bibliographical databases. EMBASE. Specialized bibliographical databases. Full-text databases. Copyright. Copying price
Health technology assessment
Introduction. General overview and concepts of evidence-based medicine and health technoogy assessment. Vocabulary of EBM and HTA. History of movement. Relations to the other health care sciences. Critical assessment of data in evidence-based medicine. Where the evidence are coming from? Search for information. Bibliographical data bases. MEDINE and serach in it. MESH terms. Strategy of searching. High specificity and high sensitivity searches. Examples. Data bases of evidences (Cochrane library, ACP Journal Club) Analysis of the reports of harm and etiology. Types of the epidemiologc investigations. Cohort studies. Prospective and retrospective cohorts. Case-control studies. Nested case-control studies. Longitudinal studies. Bias in epidemiology. Confounding. Harm data bases. Critical assessment of the reports on harm/ etiology General overview of the theory of diagnosis. Sensitivity and Specifiity of a diagnostic test. Test accuracy. Validity and reliability. Reciever-Operator Charateristic (ROC) curves. Predicitive value. Influence of the pretest probability on test selection and results evaluation. Critical assessment of the reports on diagnostc tests. Theory of experimental design. Errors of the I and II type. Power of the study. Classification of studies basing on type I and II errors. Sample size. Calculation of sample size for the studies. Clnical and experimental studies. Types of studies. Randomization. Control groups. Blindness. Organization of the RCT. End points. Critical assessment of the clinical experimental studies (treatment reports). Systematic reviews. Methodology. Strength of evidences. Example and results of implementation. Dissemination of findings. Meta-analysis. Methodology. Statstical issues. Effect size estimation. Methods of combination of correlation coefficients, standardized means and odds ratio. Publication bias. Graphical methods of meta-analysis. Examples of meta-analysis. Critical assessment of meta-analytic reports. Guidelines.Construction of evidence-based guidelines. Strength of evidences. Clinical decision analysis. Game theory as basis for rational decision under uncertainaty. Decision trees. Utility elicitation (standard gamble, time trade-off, wiingness to pay). Analytical hierarch process. Markov modelling. Critical appraisal of the decision analysis reports. Economical analysis. QALY.Health technology assessment. Health economics. Critical appraisal of economical papers. Health technology assessment agencies. International society for technology assessment n health care. Prognosis. How the sudies of prognosis are organized and conducted. Bias in the studies.Why such studies are important for clinicans.Critical assessmant of the sudies of prognosis. Ethical and organizational problems in EBM and HTA.
Clinical decision analysis
Introduction. Uncertainty. Utility. Methods of utility elicitation - standard gamble, time trade-off, willingness to pay. Matrix game theory. Payment matrix. One-move and multiple-move games. Minimax and maximin. Decision trees. Tree - building and analysis. Outcome probability and its sources. Sensitivity analysis. Decision-making in diagnostic uncertainty situation. Analytical hierarchy process. Process description. Peculiarity of analytical matrix. EBM indicators and AHP. Markov modeling. Markov process and Markov chain. Using Markov models for QUALY determination. Cases of constant and time-dependent probabilities. Economical analysis of the modeling results. Critical appraisal of clinical decision analysis articles.
Preparation of scientific report. Systematic approach to article writing. Article, audience and selection of journal. Literature search. Materials and tools for article writing. Content and format of the article. Critical arguments and structure of scientific article. General principles for structure and content. Reporting clinical trials and observational studies. Reporting laboratory research. Review article and meta-analysis. Case report and case-series analysis. Editorial. Writing and revising article. Text. Titles and abstract. Tables. Illustrations. Preparing final manuscript. Publication. Submitting paper to the journal. Peer-reviewing and editor's decision. Correcting edited manuscript or proof. Bibliographical software.
Health promotion program
Prevention of the chronic diseases in Russia in XXI century: development and perspectives. Strategies of prevention: population-based and high-risk. What is "Health promotion"? Medical and epidemiological basis of health promotion. Risk factors. What is healthy life style? WHO health for all 21. National and local health promotion programs. Health promotion policy. Investment in health. The role of medical profession in health promotion. Patient education principles. Interdisciplinary collaboration. Team work. Interaction with mass media. Innovation-diffusion theory. Behavioral basis of health promotion. Needs assessment. Health indicators. Principles of health intervention evaluation. Major risk factors and their prophylactics Smoking. Alcohol . Drug addiction . Infectious diseases. Safety and trauma prevention. Mental health. Physical activity. Diet . Health of older adults Environmental health. Health promotion methods. School programs. Health promotion on workplace. Modern technology and health promotion. Health promotion in a family. Primary care and health promotion. Equity and health. Health for all. Principles of devising health promotion programs. CINDI seminar. Training «Helping people change» Creation of local health promotion programs.
The Strategy of Preventive Medicine
The objectives of preventive medicinež The scope for prevention. Why seek to prevent? The economic and humanitarian arguments. Priorities: a matter of choice. Whaf needs to be presented? Sick individuals: a continuum of disease severity: case definitions. A continuum of risk: the prevention paradox; mass and individual measures. A unified approach. The relation of risk fo exposure The dose-effect relationship. The limitations of research methods. Small but widespread risks: a public health disaster? Prevention for individuals and the 'high-risk' strategy. Prevention and clinical care. The high-risk strategy. Identiiying risk: screening. Strengths and weaknesses of the high-risk strategy. Individuals and populations. Individual variation: genetic, social, and behavioural deterrninants of diversity. Variation between populations. Sick and healthy populations. Some implications of population change. Effects of the population average on the occurrence of deviance. Health implications for the population as a whole. Safety. The population strategy of prevention. Principles: the sociological, moral and medical arguments. Scope, proximal and underlying causes. Strengths. Limitations and problems. Scientific justification for change. Social engineering versus individual freedom. Ereedom of choice. Role of governments. Critique of the population strategy. 'Healthism'. Medicalization of the society. Social and Cultural iatrogeny.
MEDICAL PSYCHOLOGY AND SOCIOLOGY
Theoretical questions of medical psychology
Subject of medical psychology. Major principles. Psycohygene and mental health prevention. Personality in medical psychology. Theories of personality. Theories of the mind. Biological theory. Neurochemical basis of behaviour. Neuromediators and neurotransmitters. Psychopharmacology and psychosurgery. Behaviorism. Psychoanalysis. Cognitivism
Methods of psychodiagnostics
Methods of psychodiagnostics. Methods of personality study. Questionnaires. MMPI. 16-PF. Ink-blot test. Colour test (Lusher). TAT. Frustration test. Idiographic tests. Q-sort. Repertory grid. Methods of investigation of psychic processes and conditions. Methods of interpersonal relations analysis. Sociometry. Psychosomatic types. Structured interview and Jenkins type A questionnaire. Using MMPI in internal medicine. Hostility and its measurement. Methods of psychological investigation in psychiatry and narcology. Strengths and limitation of questionnaires
Psychological basis of psychotherapy.
General characteristic of psychotherapy. Individual and group psychotherapy. Patient-doctor relationships. Transference and countertransference. Psychological peculiarities of psychotherapist. 'Burn-out' syndrome. Ethical questions of psychotherapy. Values. Ethical conflict. Deontology, virtue theory and utilitarism.
Methods of psychotherapy
Methods of symptom-centered psychotherapy. Suggestion. Hypnosis. History and present time. Behavioral and cognitive methods. Methods of client-centered psychotherapy. Reconstructive psychotherapy. Humanistic psychotherapy. Dynamic psychotherapy. Methods of group-centered psychotherapy. Family psychotherapy. Balint groups. Psychotherapy in major diseases.
Verbal and non-verbal interaction with patient. Empathy training. Body language. Correspondence between verbal and non-verbal communication. Psychological contact with pateint. Active listening. Reflective and non-reflective listening.
Psychology and health care. Psychometry.
Social psychology. Social psychology and other sciences. Theories of the mind. Biological theories, behaviorism, psychoanalysis and neofreudism, cognitivism. Communication. Motivation. Interpersonal relation. Theory and praxis of business communication. Social psychology of personality. Social preception and health. Aggression. Intimacy. Relationship development and cancelling. Intellect. Interpretation of others. Construction of interpretation and memories. Self-concept. Psychology of conflict. Roots of conflict. Resolution of conflict. Small groups psychology. Stress and distress. Methods of social psychology. Psychological diagnostics. Psychometry. Creation and validization of questionnaires. System analysis in medicine and health care. Sociometry. Transaction analysis. Stratometry.
Social Aspects Of Disease. Society And Changing Patterns Of Disease. Social Causes Of Disease. Socal Factors In Medical Practice. Health And Illness Behaviour. The Doctor-Patient Relationship. Hospitals, Doctors And Patient Care. Living With Chronic Illness. Dying, Death And Bereavement. Social Structitre And Health. Inequality And Social Class. Women As Patients And Providers. Older People, Health Care and Society. Social Process Of Defining Disease Limits Of Medical Knowledge. Critique Of Modern Medicine. Deviance, Sick Prole And Stigma. Organization Of Health Services. Health Professions. Community And Continuing Care Outside Hospitals. Prevention And Health Promotion. Measuring Health Outcomes. Organizing And Funding Health Care.
General principles. Biological and social determinism. Cognitive development (Piaget). Life cycle according to Ericsson. Problem of adaptation to death and dying. Kuebler-Ross staging.
Child development. Infancy and early childhood. Theoretical backgrounds of the breast feeding role toilet training. Emotional development of a child. Sex roles. Family role in child socialization. Middle childhood and adolescence. Emotional and social development in this period. Moral development (psychoanalytical point of view, social/learning theory, cognitive theory). Moral development by Kolberg. Social development in adolescence. Types of adolescent groups (clique, crowd). Adolescence crises.
Major topics in family sociology. Family and marriage. Family and household. Types of families (nuclear, extended, augmented). Types of family in evolutional perspective (Zimmerman's trustee, domestic and atomistic family). Role analysis in families. Structural characteristics of family (borders, transborder interaction, differentiation and specialization, territoriality)..
Comparative analysis of family development in Russia and in foreign countries.
Families and illness. The Psychosocial Typology of Illness. Genograms. The Time Phases of Illness. Chronic disorders and the Life Cycle. Family Health and Illness Belief Systems. Anticipatory Loss in Physical Illness. Treatment Issues with Families
Family sexual health.
Sexual communication. Effective communication. Love and sex. Intimacy, sex and relationships. Partner selection. Marriage, cohabitation, unmarried people and sex. Divorce. Sexuality and aging.
Epidemiology of family violence. Similarity between violence-prone families (power, social isolation). Theories of family violence. General theory. Individual psychopathology. Social learning theory (transgenerational transmission of violence). Social control theories. Feministic theories. Connection between family violence with other forms of abuse - sexual harassment, dating violence, etc. Child abuse. Incest. Elderly abuse. Strategies of prevention.
Gerontology tasks. Medical, demographical, ethnographical and social questions of human aging. Historical analysis of society treatment of older adults. Role and place of aged people in modern society. Role of the family in elderly care. Role of the elderly people in the family in Russia and foreign countries. How society treat elderly in Russia and abroad.
Theory of ethics. Ethical theories. Concepts and principles. Moral conflicts. Physicians responsibilities and patient rights. Medical ethics. Relationship between physician and patient. When to tell the truth. Informed consent. Professionals obligations', institutions, and patients rights. Hospitals and patients' rights. Nurses Obligations' and Patients Rights. Privacy and Confidentiality. Nursing Homes and Rights of Geriatric Patients. Health, Disease and Values. The scope of the Concept of Health. Health and Disease - a Value-Laden Concept? Mental Health. Suicide and the refusal of lifesaving treatment. Euthanasia. Morality of Abortion. Genetics and human reproduction. Ethics of Prenatal screening. Reproductive risk. Social justice and health-care policy. Justice and Health care. Individual responsibility for health. Microallocation decisions.
OTHER QUESTIONS OF PUBLIC HEALTH
Clinical management - an introduction into the role of leadership in clinical practice. Patient rights - a comparative perspective between Russia and West. Evidence-based medicine. Evidence based medicine and health technology assessment: background, concept and methodology. Russian perspective on Health Technology Assessment and Evidence Based Medicine. Scandinavian approach to monitoring and evaluation of outcome and quality. Disease management in primary health care - integration of health services Disease management in specialized medicine - programming for comprehensive clinical work and effective patient flow. Quality and disease management. Staff management. The role of professionalism. Relationship between professions, between nurses and physicians. Multidisciplinary teams Creation of clinical management questionnaire
Modern Principles of Management in Health Care
Demographical and epidemiological situation in North Western Russia. Demographical and epidemiological situation, level of PH Nordic comparisons of health development around the Baltic Sea. Basic Health Models - a presentation of the opposite cases. Trends in health care system restructuring and governance. Rationing and prioritising in health care - causes, debates and methodologies. International Trends in Hospital and Health Services. Financial Aspects of Health Care. The problems of market economics in Russian healthcare. Health Care Financing in Russia. The value base of health systems. Health Systems reform - New Forms of Organisations of Health Care. Health care administration. Leadership - modern views, principles and policies. Occupational Hazards in the Health Professions. The experience exchange and discussion about healthcare reforming in the North-West region of Russia
GENERAL QUESTIONS OF HEALTH CARE MANAGEMENT
Planning and management in health care
Health care policy and planning questions. Management theory. Scientific basis of management. Motivation theory. Management systems. Goal-driven management. Operational tasks. Cybernetics and management. Total quality management. Changes in human stereotypes behavior. Organizational models. Bureaucracy. Network organization. Peculiarities of the administrative work. Strategic planning in health care. Policy and planning. Implementation. Monitoring. Health care system as organization. Hospital as organization. Models of organization of health institutes. Functional model. Corporation model. Filial model. Matrix model. Marketing in Health Care. Market mechanisms in health care. Market size and market share. Modeling of demand according to Gorman. Quantitative analysis in health care. Cost-effectiveness analysis. Cost-benefit analysis. Cost estimation. Production cost. Depreciation. Liquidity. Human life cost. New organizational models.
Health Care Organization
Public health system organization. Organization of individual care. Outpatient-polyclinical help. Hospital-based care. Hospices and nursing homes. Public health. Federal founding ensuring protection health of society. Republican and local institutions. Feature a outpatient-polyclinical medical help. General practitioner. Professions of first contact (professions of general practice). Functions of general practitioner- a gatekeeper model and coordinator model. Strength and limitations of each models. Organization of work. Fee-for-service physicians and salaried physicians. The forms of organizations of medical help in the outpatient-polyclinical section. Hospital-based help. History. Types of hospital-based care. Factors of working hospital. Trends of development of care. Other institutions. Quality and cost of care. Quality of care. Audit. Evaluation of quality of care. Accreditation. Licensing. Health care cost. Methods of evaluation of cost. Questions of perfecting a quality. Constant quality improvement (Total quality management). Clinical recommendations. Planning in the public health.
Staff in health care
Professional staff. Planning of health personnel training. Classification of medical specialties. Basic training. Postgraduate training. Internship. Residency. Specialist training. Ministry of Health order N 337. Nurses training. Continuing medical education. Accreditation of medical institutions. Training in public health. Health personnel management. Licensing and control. New professions in health care.
Introduction to health economics
Demand. Consumer demand: elasticity and other useful jargon. The economics of production. Information, information asymmetry, and market structure. Moral hazard, adverse selection, and the market for insurance. Incentives, reimbursement, and market power. Values, markets and other rationing mechanisms. The economics of health
Health care institutions. Health economics. Health care demand. Insurance market. Medical services production and their cost. Profit maximization in a free market. Profit maximization in a not perfectly free market. Non-commercial tasks for health care. Government, health and health care. Government as insurer. Private insurance. Medical industry. Hospital industry. Pharmaceutical industry. Health care reform.
Evidence-based health care management
Sources of evidences. Clinical data integration. Demand management. Medical errors. Quality assurance. Screening. Diagnostic test assessment in health care management. Therapeutic effectiveness. Decision-making for managers.
Financing of health care
Increase n health care expenditure. Health care cost. Relations with general economic development. Comparison between countries. Sources of financing. Models of cost reimbursement. Fee-for-service. Cost of bed-day. Cost of hospitalization. Per capita financing. International experience in financing. DRG. RBRVS. Managed care. HMO. PPO. Health Insurance organizations (HIO). Government-regulated financing systems. Beveridge system. Bismark system.
Basics of financial analysis
Introduction: financial management, accounting. Accounting cycle, summary statements. Budget. Analysis of differences. Audit. Balance sheet. Inventarization. Depreciation. Creation of financial prognosis. Liquidity. Analysis of financial papers. Price. Dependence price from time. Discounting. Business planning.
National Health Care Systems
Soviet model. UK. USA. Nordic countries. Sweden. Finland. Germany. Health care in Subsahara Africa (Uganda, Zambia). Health care in Middle East.
Leadership characteristics. Situational leadership. Temporary leadership. Hierarchical leadership. Role of the leader. Leadership process. Selection of the leader. Leadership tasks. Responsibility of the leader. Art of leadership. Strength and weakness. Expectations of the leader and subordinate. Axioms of leadership. Vision. What is a vision. How to develop vision. Team building. Team training. Dissemination of the knowledge. What to do if subordinate refuses to follow instruction. Ten errors of the leader. Ten characteristics of the leader.
Types of motives. Primary and secondary motives. Valence theory of K.Lewin. Positive and negative valence. Content theories of motivation. Maslow hierarchy of needs. Herzberg's two-factor theory. Hawthorne effect. McGregor's theory X- Theory Y. Ouchi's theory Z. Process motivation theory. Equality theory. Expectancy theory. Behavior modification. Theory of mature and immature reactions. Motivation analysis
Why teams. Individuals and teams. Psychological types (MBTI). Compatibility of types. Group dynamics. Decision-making. Feedback. Management of meetings. Conflict management. Creativity and teamwork.
Need and organization. Needs assessment. Needs Level. Responce of services. Facility. Market, bureaucracy and assotiations. Three models to co-ordinations. Types of teams. Determination. Team of client. Types of constant teams. Network teams. Formal teams. Cooperation. Way of passing of client and resource management. Way of client in different teams. Collective responsiblity. Resource Management. Priorities. Roles of the team mates. Leadership in the team. Deciding conflicts in the team. Conflict creative and destructive. Responsiblity and decision. Decision making in the team. Relationship and joint service. Co-ordinating help in the society.
Health Care Organizations and Organization Theory; Strategy and Strategic Management; Mission, Vision, and Values. Environmental and Organizational Assessment. Understanding and Analyzing the External Environment. Competitive analysis. Understanding and Assessing the Internal Environment. Defining core competencies and competitive advantages; identifying strengths and weaknesses. Organizational culture. Strategy Formulation – Positioning the Organization. Inter-organizational Strategies. Mergers, consolidations, acquisitions. Horizontal and vertical integration. Strategic alliances. Strategy formulation. Physician-Organizational Alignment. Strategy Implementation - Organization Design and Structure. Governance. Roles and responsibilities. Power and authority. Accountability. Managing Change and Innovation. The processes of change. Facilitators and barriers to change. Strategies for implementing and institutionalizing change. Nature of strategic control. Issues in assessing effective performance. Creating high performance organizations