Education in public health in 2005. Prospects for strategic planning, progress and perspectives

The program of Master of Arts in Public Health, one of the academic programmes of the School of Public Health of Mexico, has been through a continuous process of assessment and redesign since january 1988. This process is based on the following aspects: diagnosis of the general academic situation in 1985; re-definition of the Schools' objective; design of the academic and administrative modernization process; creation of the area of Academic Programmes, and development of a project on Prospective Planning in Education in Public health to 2005. The first diagnosis of the programme showed problems within the sequence and integration of its curricular contents as well as a lack of coherence between the objectives established and the expected graduates profile. Matters such as population and environmental health were almost not considered. Through on active participation of the whole faculty, a first redesign of the programme was done. After its implementation the programme went into an evaluation process, which showed that most of the problems were solved. The remaining were eliminated through another assessment process, which final outcome was the 1989 program. As it can be seen, the programme has been going through a continuous process of review and updating. The next phase within this process will come one the project on Prospective Planning in Education in Public Health to 2005 is finished.     

Weight change in later life and risk of death amongst the elderly: the European Prospective Investigation into Cancer and Nutrition‐Elderly Network on Ageing and Health study

Abstract. Bamia C, Halkjær J, Lagiou P, Trichopoulos D, Tjønneland A, Berentzen TL, Overvad K, Clavel‐Chapelon F, Boutron‐Ruault M‐C, Rohrmann S, Linseisen J, Steffen A, Boeing H, May AM, Peeters PH, Bas Bueno‐de‐Mesquita H, van den Berg SW, Dorronsoro M, Barricarte A, Rodriguez Suarez L, Navarro C, González CA, Boffetta P, Pala V, Hallmans G, Trichopoulou A (University of Athens, Athens, Greece; Institute of Cancer Epidemiology, Copenhagen, Denmark; Harvard School of Public Health, Boston, MA, USA; Bureau of Epidemiologic Research, Athens, Greece; Hellenic Health Foundation, Athens, Greece; Institute of Preventive Medicine, Copenhagen, Denmark; Institute of Public Health, Aarhus University, Aarhus, Denmark; Center for Cardiovascular Research, Aalborg, Denmark; Institut Gustave‐Roussy, Paris, France; German Cancer Research Centre, Heidelberg, Germany; Institute of Epidemiology, Potsdam, Germany; German Institute of Human Nutrition Potsdam‐Rehbruecke, Potsdam, Germany; University Medical Center Utrecht, Utrecht, the Netherlands; Public Health and Primary Care, London, UK; National Institute of Public Health and the Environment (RIVM), Bilthoven, the Netherlands; Public Health Department of Gipuzkoa & Ciberesp, San Sebastian, Spain; Health Institute of Navarra, Pamplona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Health and Healthcare services council, Asturias, Spain; Murcia Regional Health Council, Murcia, Spain; Catalan Institute of Oncology, Barcelona, Spain; International Agency for Research on Cancer, Lyon, France; Fondazione IRCSS Istituto Nazionale dei Tumori, Milan, Italy; and Nutritional Research, Umea, Sweden). Weight change in later life and risk of death amongst the elderly: the European Prospective Investigation into Cancer and Nutrition‐Elderly Network on Ageing and Health study. J Intern Med 2010; 268 : 133–144. Objective. Later life weight change and mortality amongst elders. Design. Nested case–control study. Setting. Six countries from the European Investigation into Cancer and nutrition – Elderly, Network on Ageing and Health. Subjects. A total of 1712 deceased (cases) and 4942 alive (controls) were selected from 34 239 participants, ≥ 60 years at enrolment (1992–2000) who were followed‐up until March 2007. Annual weight change was estimated as the weight difference from recruitment to the most distant from‐date‐of‐death re‐assessment, divided by the respective time. Outcome measures. Mortality in relation to weight change was examined using conditional logistic regression. Results. Weight loss >1 kg year^?1 was associated with statistically significant increased death risk (OR = 1.65; 95% CI: 1.41–1.92) compared to minimal weight change (±1 kg year^?1). Weight gain >1 kg year^?1 was also associated with increased risk of death (OR = 1.15; 95% CI: 0.98–1.37), but this was evident and statistically significant only amongst overweight/obese (OR = 1.55; 95% CI: 1.17–2.05). In analyses by time interval since weight re‐assessment, the association of mortality with weight loss was stronger for the interval proximal (<1 year) to death (OR = 3.10; 95% CI: 2.03–4.72). The association of mortality with weight gain was stronger at the interval of more than 3 years and statistically significant only amongst overweight/obese (OR = 1.58; 95% CI: 1.07–2.33). Similar patterns were observed regarding death from circulatory diseases and cancer. Conclusions. In elderly, stable body weight is a predictor of lower subsequent mortality. Weight loss is associated with increased mortality, particularly short‐term, probably reflecting underlying nosology. Weight gain, especially amongst overweight/obese elders, is also associated with increased mortality, particularly longer term.     

Improving Global Health Education: Development of a Global Health Competency Model

Although global health is a recommended content area for the future of education in public health, no standardized global health competency model existed for master-level public health students. Without such a competency model, academic institutions are challenged to ensure that students are able to demonstrate the knowledge, skills, and attitudes (KSAs) needed for successful performance in today''s global health workforce. The Association of Schools of Public Health (ASPH) sought to address this need by facilitating the development of a global health competency model through a multistage modified-Delphi process. Practitioners and academic global health experts provided leadership and guidance throughout the competency development process. The resulting product, the Global Health Competency Model 1.1, includes seven domains and 36 competencies. The Global Health Competency Model 1.1 provides a platform for engaging educators, students, and global health employers in discussion of the KSAs needed to improve human health on a global scale.     

Multisystem Inflammatory Syndrome in Children: A commentary on a flawed public health investigation

The possibility of hepatitis C being transmitted between dental patients was the genesis of an extensive and expensive look-back investigation conducted by an Ontario Public Health Unit. This investigation was performed with a minimal knowledge of nosocomial infections of dental origin, an enthusiastic reliance on untested checklist indicators and an absence of any of the criteria justifying such an investigation. As a consequence, the entire exercise was based on the false premise that an infection control lapse had occurred. This commentary will address these flaws, and other aspects of the Public Health Unit’s response that detracted from its credibility. The provision of a realistic assessment of disease transmission in dentistry should result in Public Health Units conducting informed and mutually beneficial inspections of dental practices.     

Roentgenographic mucosal patterns in the “malabsorption syndrome“

Summary A reevaluation was undertaken of roentgenographic findings as seen in diseases producing malabsorption. Seventy-nine cases were reviewed of patients having both small-bowel series and small-bowel biopsies. The emphasis was on the evaluation of roentgenographic small-bowel mucosal patterns and their correlation with histologic changes. Absorption test results were reviewed and the patients were then grouped and discussed on the following bases: (1) normals (controls), (2) those with adult celiac disease (treated and untreated), (3) those patients with diseases manifesting primarily in thickened mucosal folds, (4) those patients having had a gastrectomy, and (5) a miscellaneous group. Criteria for satisfactory differentiation between these diseases or disease groups was developed and a practical approach to the roentgenographic differentiation of these diseases was outlined.Supported in part by Training Grant AM-5179 and Research Grant AM-09347 from the National Institutes of Health, U. S. Public Health Service.U. S. Public Health Service Trainee in Gastroenterology.     

Criteria to determine academic levels in public health

Within the academic modernization strategy that the National School of Public Health developed as a result of its merging into the National Institute of Public Health, a set of different normative standards were established in order to review its academic programs. This paper shows the specific criteria to differentiate the three graduate academic levels (specialty, masters degree and doctoral degree) that are offered by the School. This set of criteria was needed because there were misunderstanding about the goals and the contents of each of these academic programs. The present proposal was done by the Academic Program Associated Dean's team during 1987, after reviewing the academic standards at the national level for graduate programs. On the other hand, a set of criteria is proposed for the graduate continuing-education programs. These courses are seen as strategic for the training of physicians in executive levels of the health sector in Mexico.     

The Contribution of Public Health to Gerontology:

Public health brings a unique focus to the study of health and aging, but public health programs have been slow in developing such course offerings. This article presents a content analysis of 71 courses taught in public health degree programs that focus on the elderly, demonstrating both the strengths and weaknesses of providing education on health and aging in public health programs.     

Review: Health Care Decision‐Making WebCT Module for Medical Students

The Health Care Decision‐Making Module was initially created as an interactive WebCT program and was subsequently converted to a pdf format for posting on the Portal of Geriatric Online Education in early 2006 and updated on October 29, 2009. WebCT was the first of what are now many comprehensive software programs used by universities for conducting online courses. The current Health Care Decision‐Making module is a straightforward pdf with embedded hyperlinks and exercises, allowing for easy downloading, sharing, and adapting by other institutions.     

Public Health Implications of the International Alcohol Industry: Issues Raised by a World Health Organisation Project

This article reviews the research conducted during a World Health Organisation study project entitled Public Health Aspects of Alcohol Availability. This project: a) traced trends in world alcohol availability, b) outlined the international alcohol industry, c) conducted pilot studies on the impact of the industry on drinking in developing countries, and d) highlighted areas of potential policy concern. The project overview was given by Alcoholic Beverages: Dimensions of Corporate Power. This report indicated European-style commercial beverages were being diffused all over the world by transnational conglomerates using aggressive, sophisticated marketing practices. Information on the international industry's effect on alcohol consumption in developing countries was provided by pilot studies on several geographical regions. While data were preliminary, they did indicate alcohol production was expanding everywhere, with trade a crucial factor in several locales. In areas with indigenous traditional beverages, European-style beverages had supplemented, not replaced traditional drinks. The pilot areas evidenced various industry ownership patterns, each highly influenced by transnational corporations. Special studies were also commissioned, which provided information on roles alcohol can play in specific social formations, such as tourism, agricultural cooperatives, and colonialism. Although the project ended prematurely, before in-depth research was completed, it documented the importance of international economic patterns in understanding and addressing public health issues in the alcohol field.     

Factors relating to place of death of Japanese people from a small town in a rural area

The objective of our retrospective study was to clarify factors relating to place of death of Japanese people from a small town in a rural area who had been bedridden for at least one week before dying. The caregivers of subjects aged 40 and above who died during a three-year period were surveyed by trained interviewers. Of 352 subjects who died, 312 caregivers responded and agreed to a face-to-face interview. A total of 213 subjects were considered as an eligible sample. The main outcome measures were odds ratios for death at home in relation to age, pain, cause of death, and home visit service. One hundred and two people died at home, while 112 people died in a hospital. Multivariate logistic regression analysis showed that the probability of home death increased with age of the bedridden, lack of pain during the bedridden period, not having cancer as a cause of death, having senility as a cause of death, and receiving regular home visits by a Public Health Nurse. In conclusion, expansion of the home visit programs by Public Health Nurses may enable people to die at home as they so desire. Further prospective research is needed to explore the association between the attitude toward terminal care and the place of death.     

Importance of National Institute of Infectious Diseases and Institutes of Public Health on control of infectious diseases in the new century

As the incidence of infectious diseases has recently decreased, we are faced with new problems, such as emerging and re-emerging infectious diseases, food poisoning, zoonosis, and bio-terrorism. In light of these new conditions, the National Institute of Infectious Diseases, the Local Institutes of Public Health, public health offices, and other medical organization must maintain close relationship in order to protect the health and safety of the citizens.     

PHS draft guidelines recommend triple drugs as initial therapy. Public Health Service

The first government-sanctioned HIV treatment guidelines are being finalized by the National Institutes of Health (NIH) Office of AIDS Research and the National Institute of Allergy and Infectious Diseases (NIAID). The guidelines will replace those developed by the Public Health Service in 1993, before any of the protease inhibitors were approved. Preliminary data tables that indicate that triple-combination therapy is strongly recommended as initial therapy are included.     

Predicting the risk of mobility difficulty in older women with screening nomograms: the Women's Health and Aging Study II

BACKGROUND: A major obstacle to screening for early mobility disability (ie, mobility difficulty), a major public health concern, is the lack of a method that identifies those who are at high risk. The goal of this study was to develop easy-to-use clinical nomograms for estimation of the probability of incident mobility difficulty. METHODS: We conducted a population-based prospective study using data from 266 high physically and cognitively functioning older women, aged 70 to 80 years, who were free of mobility disability at the baseline evaluation of the Women's Health and Aging Study II. The outcome measure was incident mobility disability within 18 months, defined as self-reported difficulty walking 0.8 km, climbing 10 steps, or transferring from or into a car or bus. Logistic regression and receiver operating characteristic curve analyses were used for evaluation of the optimal combination of self-reported and performance-based mobility measures. Bootstrap sampling and estimation was used for validation. RESULTS: Predictive nomograms were developed based on a final model that included 3 simple-to-obtain measures of preclinical disability: self-report of modification in mobility tasks without having difficulty with them, one-leg stance balance, and time to walk 1 m at a usual pace. Final model accuracy (as estimated by the area under the receiver operating characteristic curve) was 73% (SE = 0.04). Validation analysis confirmed the high accuracy of these nomograms. CONCLUSIONS: An original tool was developed for assessment of the risk of mobility difficulty in older women that can be used to assist physicians and researchers in deciding which women to target for preventive interventions.     

Denver Health: a model for the integration of a public hospital and community health centers

Two major pillars of the United States' safety net system are urban public hospitals and community health centers. Their common mission is to care for the uninsured and other vulnerable populations. However, in most communities these important components of the safety net remain organizationally and functionally separate, which inhibits the continuum of care and creates substantial inefficiencies. Denver Health is a long-standing vertically and horizontally integrated system for vulnerable populations. The integration benefits the patient and the system and serves as a model for the U.S. safety net. This paper outlines the benefits of integration to the patient, provider, and health system, using data from the National Association of Public Hospitals and Health Systems, the Bureau of Primary Health Care, and Denver Health.     

Engaging with stakeholders to inform the development of a computer model for the NHS Health Check programme: a qualitative study

Background

The National Health Service (NHS) Health Check (NHSHC) is a risk-reduction programme offered to all adults in England aged 40–74 years. Previous studies have mainly focused on the delivery of this programme and on patient perspectives of having or not having a health check. Programme costs are substantial. Therefore, a modelling tool (workHORSE) is being developed and co-produced with key stakeholders for local commissioners to quantify effectiveness, cost-effectiveness, and equity of the NHSHC. We aimed to facilitate engagement with stakeholders; develop a shared understanding of current implementation of NHSHC; identify what is working well, less well, and future hopes; and explore features and specifications to include in the tool.

Food consumption and glycemic testing of adults and elderly diabetic patients from Public Health: A systematic review of assessment methods

AimsTo map and discuss the different methods used to assess food consumption and glycemic testing of adults and elderly diabetic patients from Public Health.Materials and methodsA total of 710 records were identified by searching databases integrated by the Virtual Health Library website, between September and October 2017. The Newcastle Ottawa scale was used for study quality assessment. A total of 8 studies met inclusion criteria for analysis. Study characteristics were extracted and synthesized to generate comparisons.ResultsFood consumption was evaluated by Food Frequency Questionnaire, 24-hour Dietary Recall, Eating Attitudes Test (EAT-26), Questionnaire On Eating and Weight Patterns (QEWP-R), and questioning the salt intake. Glucose testing methods included Postprandial Glucose, Glycated Hemoglobin (HbA1C), fasting glucose, and self-reported diabetes.ConclusionsMost methods that access food consumption use single questionnaires, which are easy to administer and yield easily interpreted results. For glycemic testing, the majority used are conventional methods.     

Mapping knowledge domains: characterizing PNAS

A review of data mining and analysis techniques that can be used for the mapping of knowledge domains is given. Literature mapping techniques can be based on authors, documents, journals, words, and/or indicators. Most mapping questions are related to research assessment or to the structure and dynamics of disciplines or networks. Several mapping techniques are demonstrated on a data set comprising 20 years of papers published in PNAS. Data from a variety of sources are merged to provide unique indicators of the domain bounded by PNAS. By using funding source information and citation counts, it is shown that, on an aggregate basis, papers funded jointly by the U.S. Public Health Service (which includes the National Institutes of Health) and non-U.S. government sources outperform papers funded by other sources, including by the U.S. Public Health Service alone. Grant data from the National Institute on Aging show that, on average, papers from large grants are cited more than those from small grants, with performance increasing with grant amount. A map of the highest performing papers over the 20-year period was generated by using citation analysis. Changes and trends in the subjects of highest impact within the PNAS domain are described. Interactions between topics over the most recent 5-year period are also detailed.     

Hypertension labelling was associated with poorer self-rated health in the Third US National Health and Nutrition Examination Survey

Individuals labelled as having hypertension tend to report poor self-rated health (SRH), but it is unclear whether this association is independent of actual hypertension, socioeconomic status and adiposity, and extends across racial and ethnic groups. In a cross-sectional study we compared hypertensive and normotensive individuals (N = 19,057) who varied in whether they had ever been labelled hypertensive. Blood pressure was measured in participants' homes and mobile examination centres in the United States as part of the Third National Health and Nutrition Examination Survey, 1988-1994. The main outcome measure was global SRH. Hypertensive labelling was associated with poorer SRH and was independent of established SRH predictors, antihypertensive medication use, body mass index, and hypertension status (adjusted odds ratio (OR) = 1.79, 95% confidence interval (CI), 1.61-1.99). Hypertension was also associated with poorer SRH (OR = 1.26; 95% CI 1.09-1.46) but this association was eliminated by adjustment for hypertensive labelling (OR 1.06; 95% CI 0.92-1.22). These effects were consistent across non-Hispanic white, non-Hispanic black, and Hispanic subgroups. Individuals labelled hypertensive are more likely to have lower SRH and this labelling effect predominates over that of actual hypertension. Public health efforts to increase the number of individuals screened for high blood pressure may successfully detect the presence of hypertension but may also reduce health-related quality of life as measured by global SRH.     

Nursing of tuberculosis patients--quality nursing to support patient's compliance to treatment

Tuberculosis control program in Japan focuses more on completion of treatment. The activities for patients to complete treatment are being actively done with collaboration between nurses of hospitals and public health nurses of the health centers. In 2000, Ministry of Health Welfare announced DOTS program version Japan. As a result, health centers of big cities implemented DOTS for homeless tuberculosis patients and hospitals DOT for in-patients. In 2003, the government demonstrated the scheme of DOTS strategy Expansion Program version Japan, which includes community DOTS types to be selected depend upon the risk of default with an individual patient. It is necessary to develop and utilize social and human resources in the community to expand surely supporting system for patient's compliance. Mutual understanding and collaboration of the relevant organizations become very important. In this symposium, four panels from hospital, clinic and public health center discuss on the current situation and challenge of supporting system and the assessment of treatment outcome. 1. DOTS implementation with collaboration on nursing activities between hospital and public health center in Kyoto Prefecture: Ikuyo HIROHATA (National Hospital Organization Minami Kyoto National Hospital). 2. From standpoint of clinical practice: Hidenori MASUYAMA (Japan Anti-Tuberculosis Association Shibuya Clinic). 3. The activities for case support based on DOTS Program in Wakayama Prefecture: Kimiko KAWASAKI (Tanabe Public Health Center, Wakayama Prefecture). 4. Assessment of supporting activities for patient's compliance: Tomoko TAKANO (Uki Public Health Center, Kumamoto Prefecture). Three speakers gave additional comments and advice on quality supporting and nursing activities for patient's compliance through good coordination between hospitals and publics health centers.