The Establishment of the School of Public Health at the State University of New York,Downstate Medical Center: The First Nationally Accredited School of Public Health in a Public University in New York City

The State University of New York (SUNY), Downstate Medical Center initiated a Master of Public Health (MPH) degree program in July 2001 following planning efforts that began in 1995. Twelve students entered the program in June 2002, and currently some 110 MPH students and 12 Doctor of Public Health (DrPH) students are enrolled. This article describes the long and complex process of transforming the original MPH degree program, with its single focus on urban and immigrant health, with a student enrollment of 12 and 8 full-time faculty, into a school of public health with a large student enrollment of 122 students, 25 full-time faculty, five MPH degree tracks, and four DrPH degree tracks. The process of establishing the SUNY Downstate School of Public Health in 2009 from its inception as an MPH program in 2001 spanned a period of 8 years. This process was guided by a commitment to two basic principles. The first was to maintain the original 2005 program accreditation by the Council on Education for Public Health (CEPH). The second was to sequentially secure accreditation for all subsequent four MPH and four DrPH degree tracks through CEPH’s procedure of substantive change approval. This policy assured continuous national CEPH accreditation of the original Urban and Immigrant Health MPH degree track and all added degree programs. The 5-year period following the initial CEPH accreditation of the MPH program in 2005 was one of intense development during which all of the essential elements for CEPH accreditation of a school of public health were put into place. This rapid development was made possible by the vision and full support of Downstate’s president, John C. LaRosa, MD, FACP, and the dedicated efforts of many. This included the students, faculty, staff, and administrators of the School of Public Health, the school’s Community Advisory Group, several external advisors, and many in the medical center’s Central Administration, College of Medicine, School of Graduate Studies, College of Nursing, College of Health Related Professions, and the University Hospital of Brooklyn. From the very beginning of the planning phase for an MPH program and through the ultimate accreditation of the School of Public Health in 2010, broad participation was solicited from all major units in the medical center. Thus, the MPH program became a center-wide initiative and not merely that of the College of Medicine’s Department of Preventive Medicine and Community Health. This broad participation has been continuously maintained through the involvement of leaders of other medical center academic units and the University Hospital of Brooklyn in the program’s and then the school’s standing and ad hoc committees, and in other activities as well. Similarly, community representation has been maintained, some through formal linkages relevant to the practical field experiences required of all students. In October 2010, the Board of Councilors of CEPH accredited the SUNY Downstate School of Public Health for a 5-year period through 31 December 2015. The accreditation of the school was a major milestone for Downstate, Brooklyn, and New York City. The SUNY Downstate School of Public Health is the first CEPH accredited school of public health in the history of Brooklyn, and only the second such school in New York City. It is also the first CEPH accredited school of public health at a publicly supported university in New York City. The school has already had a major impact on improving the health and well-being of the people of Brooklyn through its numerous collaborative community-based health promotion and disease prevention programs.     

A Third World International Health Elective for U.S. Medical Students: The 25-Year Experience of the State University of New York, Downstate Medical Center

The Department of Preventive Medicine and Community Health at the State University of New York, Downstate Medical Center instituted a 6-8 weeks third world international health elective for fourth year medical students in 1980. Since that time, some 217 students have participated in a score of third world countries. However, the most popular sites have been India, Kenya and Thailand. The purposes of this elective are to provide fourth year medical students with an opportunity to observe and study the structure and functions of a health care delivery system in a third world country, to provide medical service, and to have a cross-cultural experience. The emphasis in this elective is on public health, preventive medicine and primary care. There are high levels of student competition for this elective. However, interest in it has been affected by world events such as the terrorist attacks of September 11, 2001 and the recent outbreak of Severe Acute Respiratory Syndrome (SARS) in Asia. Recent annual applications for this elective have been twenty-five and more out of a class of two hundred students. Annual acceptance rates vary considerably, ranging from as low as 27.2% in 1995-1996 to a high of 81.8% in 1987-1988. Careful screening, including an examination of academic records and personal interviews, has resulted in the selection of highly mature, adaptable, and dedicated students who overall have performed well at overseas sites. Student rated satisfaction levels with this elective are extremely high, with most rating it the best experience of their medical school years. Students undergo extensive preparation prior to going overseas. This includes individual health and safety issues, travel and lodging, and the nature of the host country culture, health care system, and assignment site. Our students are especially experienced in cross-cultural understanding because of the unusual diversity of the patients they treat in Brooklyn, and the ethnic diversity of local hospital staff and the medical school class. This Brooklyn experience in cross-cultural understanding has been cited by many participants as having been the best preparation for functioning in a foreign culture. In the late 1990s, we revised our procedures concerning health preparations so as to address the risk of HIV/AIDS and other blood borne diseases. In addition, we also adopted an Agreement and Release form containing 15 provisions requiring risk and responsibility assumption on the part of the student participants. The Alumni Fund of the College of Medicine has steadfastly supported this elective with both a philosophical commitment and financial grants to help defray travel costs. In 1998, Joshua H. Weiner of the class of 1941 created a sizeable endowment in the Alumni Fund of the College of Medicine to support students participating in this elective. In 2001, Sonja K. Binkhorst, Assistant Professor of Psychiatry at the Downstate Medical Center, arranged for some financial support for women medical students through the LSK Foundation and the American Medical Women's Association. During the years that this elective has been offered, overseas preceptors have willingly given of their time and institutional resources to make these experiences available and meaningful for students.     

中外公共卫生硕士(MPH)培养模式比较与思考

目的新冠肺炎疫情暴露了我国公共卫生体系中长期以来积累的短板,其中最难以忽视的是优秀公共卫生人才的短缺,而作为培养高素质人才的公共卫生硕士(master of public health,MPH)传统教育已不能满足社会的需求,文章旨在为深化我国MPH教育改革提出参考性建议。方法采用案例比较的方法选取中英美三国中六所具有典型代表的高校进行研究。结果围绕其培养目标、招生生源、培养方式、课程设置、实践基地、毕业考核等方面进行中外对比和深入剖析,发现我国MPH培养过程中存在一些不足。结论应针对我国MPH培养体系中的诸多问题开展深入讨论并进行相应的改革。     

Using Concept Mapping in the Development of a School of Public Health

Schools of Public Health have a wide variety of essential stakeholders. Broad input in program planning should assist in ensuring well-developed plans and strong community buy-in. The planning of a school can better address the needs of multiple stakeholders from systematic broad-based input from these constituents using concept mapping. In this study, we used concept mapping to prioritize a set of recommendations from diverse stakeholders to assist in the process of planning a school. A set of statements was generated on essential elements for the proposed school from a broad group of stakeholders. The statements were then distilled into unique themes, which were then rated on importance and feasibility. Cluster maps and pattern matches were used to analyze the ratings. Unique themes (N = 147) were identified and grouped into 12 clusters. Cluster themes included leadership, faculty, culture, school, and curriculum. Pattern matches revealed a significant, modest correlation between importance and feasibility (r = 0.27). A broad range of perspectives was used to identify relevant areas to address in the development of a school.     

医疗机构突发公共卫生事件监测能力现状分析及改善对策

本研究采用分层抽样的方法,对黑龙江省19家医疗机构的299名相关的医疗服务人员进行了调查,调查采用了定性与定量相结合的研究方法,以了解医疗机构突发公共卫生事件监测能力的现状,比较不同层级、部门等医务人员的监测能力差异,以及影响医疗机构医务人员监测报告能力的因素,并提出了相关的政策建议,以完善医院在突发公共卫生事件监测系统中的作用。     

培养医学生应对突发公共卫生事件能力的实践与探讨

目的探讨培养临床医学生应对突发公共卫生事件能力的教学模式。方法自2003年起在临床医学本科三、四、五年级学生进行培养应对突发公共卫生事件能力教学实践。结果预防医学教学、传染病学教学和生产实习相结合的培养学生应对突发公共卫生事件能力的教学模式，激发了学生的学习积极性，培养了学生应对突发公共卫生事件的能力。结论使用预防医学、传染病学和生产实习相结合的教学模式对提高学生应对突发公共卫生事件能力有重要的意义，值得推广。     

Development of a Master of Public Health programme in Tirana, Albania

In 2001, two Albanian institutions, the Department of Public Health, Faculty of Medicine, University of Tirana and the National Institute of Public Health obtained membership to the Association of Schools of Public Health for the European Region (ASPHER). Since 2000, these two institutions have been members of the Public Health for South Eastern Europe (PH-SEE) network. Furthermore, in the fall of 2001, the Open Society Institute (OSI) and ASPHER launched a project that culminated in the establishment of a School of Public Health (SPH) and the commencement of the first Master of Public Health (MPH) programme in Tirana. The MPH programme began in December 2005 and enrolled 32 students from different backgrounds. A suitable start for the development of the MPH programme was the implementation of key modules developed by the European MPH programme. In addition, specific modules reflecting the needs of Albania were designed according to the preferences and the heterogeneous lecturing faculty involved in public health training. International guest lecturers delivered other modules, with ASPHER and the PH-SEE network offering an excellent solution for complementary modules in different public health disciplines. However, the newly established SPH in Albania should now strive for other postgraduate teaching programmes, undergraduate programmes, and especially service training and continuing education.     

Assessing Competencies of the Public Health Workforce in a Frontier State

The purpose of this study was to determine the level of perceived proficiency of a public health workforce based on the Public Health Practice Core Competencies. The Public Health Profile and Training Needs Assessment questionnaire was mailed out to public health employees representing mostly public health nursing, environmental health, mental health, and public health management/administration (n = 696). Nearly three-quarters (74%) of participants were female and 96% reported being white. Eighty one percent of participants were currently employed full-time. The majority of participants were trained at the bachelors level (54%). The response rate was 63.9%. Findings from this study show that all disciplines reported higher perceived proficiency in the Communication skills domain compared to the other seven skills domains. Perceived low skills domains included financial planning and management skills and policy development/program planning skills among public health nurses, mental health professionals, and environmental health specialists. Management/administration level staff reported their lowest perceived proficiency in Basic Public Health Science skills. Each group had different strengths and weaknesses and the necessary level of skill needed differs among discipline groups, thus future trainings on the Public Health Core Competencies should be discipline specific.     

用“公共卫生路径”的思路控制公共卫生质量和成本

目前状况下的农村卫生工作是极具中国特色、极富挑战的研究内容，理清卫生工作理论和实践两方面的线索是当前亟需解决的重要问题。由于公共卫生成本需求不能完全与高成本需枣的医疗服务相比，因此，不能简单地以公共卫生费用占卫生事业费份额作为标准来对公共卫生投入是否适宜进行评价。公共卫生服务工作亟需健全标准化、完整的、规范化、量化的，以服务的绩效质量为标准的计划、实施、评估体系。     

公共卫生、医疗服务、医疗保障多体系协同机制研究--基于整体性治理理论视角

抗击新冠肺炎疫情是对国家治理体系和治理能力的一次大考,然而目前我国公共卫生、医疗服务与医疗保障体系间的协同机制尚未建立。本文基于整体性治理理论,将构建协同机制的要素进行四维整合;通过剖析三体系协同运行的现状,提出树立共同的价值理念、整合现有制度规范、建立协调整合机制、革新信息平台建设等建议,为探索合理可行的多体系协同机制带来启示。     

The Effectiveness of a Health Promotion Program for the Low-Income Elderly in Taipei,Taiwan

This study assessed the effectiveness of a health promotion program for low-income elderly provided by trained low-income home health aides. Indicators of the effectiveness of this program included improvement in physical health, psychosocial health and functional status, including activities of daily living (ADL) and instrumental activities of daily living (IADL) as well as changes in perceived health promotion needs. This evaluation study used a single group pre- and post-test experiment design. After informed consent forms were signed by participants, 89 purposively selected low-income elderly (aged 64–96) completed pre-test structured surveys, while 60 participants (aged 68–96) completed post-test surveys. Post-test scores indicated improved nutritional status (paired t = 2.64, p < .05) and chore management of IADL abilities (paired t = 2.83, p < .01). No significant difference in psychosocial status were found between pre- and post-test scores. Perceived needs for health promotion services decreased after the intervention. The results show that the health promotion services were effective in improving health status and decreasing perceived needs for services among low-income elderly in Taipei. Recommendations based on this study for developing services for the low-income elderly must take health promotion intervention into consideration.     

北京地区医务人员对应对突发公共卫生事件薄弱环节认知情况的调查分析

目的了解各级医院医务人员对目前应对突发公共卫生事件的管理现状,尤其是薄弱环节所获数据为全国各医院健全突发公共卫生事件的应急机制,完善应急处置预案提供有益的借鉴和参考,为政府相关部门制定突发公共卫生事件应急体系提供可靠依据.方法采用抽样问卷调查方法,对北京地区15家医院和2家医疗卫生单位的1223名医务人员进行有关突发公共卫生事件及救治知识的认知情况、管理现状、救治能力等方面的调查.结果应对突发公共卫生事件的管理水平和救治能力亟待提高.结论政府和各级卫生行政部门要重视救治常识的宣传教育、公共卫生体系的建设、医院应急预案的完善,提高医院的危机管理水平和医务人员的救治能力.     

面向公众的网络医疗健康信息质量分析简

医疗健康所含信息量远超于其他学科,也是公众关注的重中之重。网络环境下信息的高速传输使公众获取信息更加及时、便利。本文研究分析网络医疗健康信息质量上存在的问题以及给公众使用带来的障碍,为提高公众使用网络医疗健康信息质量,从而提出从搜索引擎改善、信息规范及用户培训三方面建议。     

对新形势下保健中心发展之路的思考

国际旅行卫生保健中心在发展过程中形成了一定的特色,但不断发展的检验检疫事业对保健中心也提出了更高的要求。保健中心在新形势下该如何进一步提升能力、发展壮大,本文主要从管理、人才、服务、市场以及科研等方面加以探讨。     

An Evaluation of the Effects of a Breastfeeding Support Program on Health Outcomes

ObjectiveTo estimate the causal effect of a Michigan peer counselor (PC) breastfeeding support program for low-income women on infant health outcomes.ConclusionsThis Michigan PC breastfeeding support program resulted in improvements in breastfeeding and infant health outcomes as measured by the diagnosis of ailments while increasing health care utilization.     

远程医学在应对突发公共医疗卫生事件中的应用探讨

摘　　要　远程医疗会诊网络在突发公共医疗卫生事件中不仅实现了远程会诊的功能,而且在信息沟通、联络等方面也发挥了重要作用,其成功应用为今后应对突发公共医疗卫生事件提供了重要启示。     

对建构突发公共卫生事件应急培训评估模型的探讨

培训质量评估是培训和再培训的保证和基础,是每个培训不可或缺的重要组成部分,因此突发公共卫生事件应急培训也离不开评估。通过对经典培训评估模型Kirkpatrick四层次模型、Kaufman五层次模型、Philips五层次ROI框架模型、CIRO模型和CIPP模型进行介绍和评价．探讨各模型对评估突发公共卫生事件应急培训的适宜性,以求对我国突发公共卫生事件应急培训评估体系的建设有所启示。     

Crowd-Out in the State Children's Health Insurance Program (SCHIP): Incidence, Enrollee Characteristics and Experiences, and Potential Impact on New York's SCHIP

Background. The extent to which the State Children's Health Insurance Program (SCHIP) crowds our private insurance is poorly understood.
Objective. To assess the incidence of crowd-out and enrollee characteristics associated with crowd-out.
Data. Parent telephone survey for 2,644 children after enrollment in NY SCHIP.
Measures and Analyses. Crowd-out is measured based on enrollee reports of coverage (and loss of coverage) before SCHIP. Multivariate logistic regression is used to relate crowd-out to enrollee characteristics.
Principal Findings. Only 7.1 percent of SCHIP enrollees dropped private coverage ≤6 months before SCHIP, suggesting relatively modest crowd-out. Crowd-out was associated with some enrollee traits including income, but not with health status.
Implications. Most movement from private to public insurance in NY was not crowd-out. Under current program structure in NY, crowd-out concerns should not dampen enthusiasm for SCHIP.