国内外公共卫生专业硕士( MPH)育现状及发展启示

公共卫生硕士(MPH)是国际公认的公共卫生领域主流学位,是为公共卫生领域培养的一种高层次专门人才,相对于传统公共卫生科学硕士的教育培养,MPH更侧重于实际工作能力的培养.发达国家十分重视MPH培养.我国MPH教育起步较晚,但经过抗击SARS、AIV及甲型H1N1流感等几次重大公共卫生突发事件考验,加强MPH教育的重要性与必要性已得到全社会的进一步认可.为此,在调研了国际MPH教育的发展、现状和趋势基础上,分析探讨了我国MPH教育现状及其存在的问题,并为今后提高我国MPH教育质量及未来MPH教育的发展提出了加强行业和岗位从业资格与专业学位的衔接、加大招生宣传和拓宽招生渠道、优化培养过程和教学模式、注重国际交流和加强合作培养,以及建立对MPH培养质量科学评估体系等建议.     

中美公共卫生硕士教育比较研究

[目的]比较中美公共卫生硕士(Master of pubic health,MPH)教育情况,发现差距,提出相应的政策性建议. [方法]对我国开展MPH教育的所有培养单位进行现况调查,采用自填式问卷和数据库收集信息,调查对象为MPH教育具体负责人.通过文献检索综述、查询互联网资料获得美国MPH教育相关情况.进行比较研究.[结果]得到中美MPH教育在培养单位与培养目标、学生情况、专业设置与攻读人数、学习时间与方式4方面的差别. [结论]与美国较为成熟的MPH培养模式相比,我国现行的教育模式还有一定的差距.通过中美比较,可以提供以下借鉴:我国的MPH教育模式需要理清层次;建立专门的认证程序和机构;适当控制MPH的招生人数;注意吸收多种职业背景、培养公共卫生护士,加强行为学与健康促进培养;增加网络教学.     

美国约翰·霍普金斯大学全日制公共卫生硕士培养模式探析

从培养目标、培养计划、课程设置和毕业论文等方面介绍了美国约翰·霍普金斯大学全日制公共卫生硕士(master of public health,MPH)培养模式,分析了其培养特点,对我国全日制MPH教育提出了明确培养目标、科学设置课程、提升实践效果等建议。     

22所大学将招收公卫硕士

我国首次设置的公共卫生硕士专业（MPH)开始招生。首批教育试点学校全国共有22所。 公共卫生硕士是国际公认的公共卫生领域的主流学位。今年在我国首次设置的MPH教育主要以培养公共卫生高层次应用型人才为主，强调人才培养与我国公共卫生实际需要相结合，采取理论学习、社会实践、课题研究三结合的培养模式，注重培养学生解决公共卫生实际问题的能力和组织管理能力。 MPH学制一般为2～4年，按一级学科设置课程。据了解，设置和试办该专业学位是我国医学学位与研究生教育制度改革的一项重要举措，首批教育试点选在了综合实力较强的…     

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。     

国内外公共卫生专业硕士( MPH)育现状及发展启示

公共卫生硕士(MPH)是国际公认的公共卫生领域主流学位,是为公共卫生领域培养的一种高层次专门人才,相对于传统公共卫生科学硕士的教育培养,MPH更侧重于实际工作能力的培养.发达国家十分重视MPH培养.我国MPH教育起步较晚,但经过抗击SARS、AIV及甲型H1N1流感等几次重大公共卫生突发事件考验,加强MPH教育的重要性...     

系统论视角下国内外公共卫生硕士培养方案要素的比较

  目的  比较国内外部分代表性院校公共卫生硕士(Master of Public Health, MPH)的培养方案,分析影响培养质量的核心要素,为我国MPH的培养提供优化意见与建议。  方法  通过数据库、院校官网等途径收集目标院校MPH培养方案及人才培养相关政策,根据系统论从培养目标、培养模式、课程设置、专业实践及考核评价5个要素进行比较分析。  结论  (1) 要以胜任力为导向做好培养方案的整体设计,加强培养各环节要素的协同,保持培养体系自我调整发展的能力;(2)宽口径、跨学科融合支撑的课程体系是培养复合型、应用型高层次公共卫生人才的重要基础,可以通过设置课程模块增加自主选择的空间以适应多元化的培养要求,创新教学方法以培养学生的自主学习能力;(3)实践能力是MPH培养的核心重点,实践时长、实践领域与内容、考核评价方式都是确保培养质量的重要因素。     

公共卫生硕士专业学位培养标准制定

我国试办公共卫生硕士专业学位（MPH）研究生教育已十余年,但仍存在许多问题制约了培养质量。本研究旨在通过制定相应的培养标准,对MPH毕业学生的核心能力进行界定,为培养单位提供有益的参考。     

美国公共卫生双学位研究生教育发展趋势研究

目的 分析美国公共卫生双学位研究生教育在近10年的发展状况,探讨其发展趋势及对我国研究生教育改革的启示.方法 收集2001～2010年间美国公共卫生双学位研究生培养的报告数据,结合约翰霍普金斯大学、哈佛大学、耶鲁大学等公共卫生学院的相关资料;采用Excel建立数据库并对数据进行比较分析.结果 在培养形式方面,双学位研究生与单一学位研究生差异有统计学意义(x2=747.589,P＜ 0.001);双学位类型多达51种,MPH和其他学位相结合的双学位有35种;2008～2010年共有2 948名公共卫生双学位研究生注册,占10年总注册人次的42.37％.结论 MPH与其他学位相结合是公共卫生双学位的主流形式,社会对公共卫生双学位的需求日渐增加,我国须加大专业学位研究生双学位的培养力度.     

以胜任力为导向的公共卫生硕士校外实践培养体系的构建探索

目的 探索构建以胜任力为导向的公共卫生硕士（MPH）校外实践培养体系。方法 通过文献检索,分析国内外MPH专业学位培养模式,以胜任力为导向创新设计一个全面的、可行的MPH校外实践培养体系。结果 中山大学-广州市CDC高水平公共卫生人才培养示范基地针对实践时长2年以上的MPH探索构建了“4+N+综合评价”的实践体系,“4”代表基于实践的教学、专业实践、公共卫生项目管理参与和科研训练,分别培养MPH“公共卫生科学”“操作与实践”“人群健康管理”“卓越技能”能力。“N”代表拓展实践,培养MPH“综合能力与职业精神”能力,以综合评价来评估培养效果。结论 本研究构建以胜任力为导向的MPH“4+N+综合评价”校外实践体系,培养新时期社会需求的高层次应用型公共卫生人才。     

Vocational support in mental health service delivery in Australia

Background: Individuals experiencing severe and persistent mental illness report a desire to gain and sustain work. Individual Placement and Support (IPS) is an evidence-based approach to vocational rehabilitation to support competitive employment outcomes.

Aim/Objective: This study aimed to evaluate whether a joint-governance management partnership, between a clinical adult mental health and an employment service, could deliver a sustained IPS program in Australia.

Materials and Method: The methodology entailed a Clinical Data Mining approach, to examine records from seven years of implementation of IPS in one setting within an Australian public mental health service context.

Results/Findings: Despite the prevalence of schizophrenia spectrum diagnoses and an older mean age (39 years), indicating that a large proportion of the cohort had experienced serious mental illness for over twenty years, findings were that 46.3% of participants achieved employment.

Conclusions: This is an excellent result and is comparable to the only randomised control trial, with adult services, in the Australian context, which found a 42.5% employment rate possible under IPS compared with just 23.5% with referral to external employment services.

Significance: More extensive trialling of IPS across clinical services is required, in Australia and internationally, including fidelity protocols, for knowledge translation to be achieved.     

Occupational balance in health professionals in Sweden

Background: Health care employees are often women, a group that has high degrees of sick leave and perhaps problems attaining occupational balance. However, people think differently about their everyday activities and it is therefore important to take their perceptions into account but occupational balance has not yet been measured in health professionals. The aim was to describe occupational balance in three different samples of health professionals in Sweden. A further aim was to investigate whether occupational therapists (OTs) rate their occupational balance differently from other health professionals.

Material and method: Four hundred and eighty-two health professionals, employees in public dentistry, mental health care and OTs, aged 21–70 years participated. The participants’ occupational balance was measured using the occupational balance questionnaire (OBQ).

Results: The ratings of occupational balance were similar to earlier studies and did not differ significantly between the samples. The OTs’ occupational balance was also similar to that of the other health professionals.

Conclusion: The similarities in occupational balance indicate the same difficulties in attaining it.

Significance: The result highlights the possibility that working people face similar difficulties in achieving occupational balance. Further research is warranted about how to attain it.     

21st century research in urban WASH and health in sub-Saharan Africa: methods and outcomes in transition

Tackling global inequalities in access to Water, Sanitation and Hygiene (WASH) remains an urgent issue – 58% of annual diarrhoeal deaths are caused by inadequate WASH provision. A global context of increasing urbanisation, changing demographics and health transitions demands an understanding and impact of WASH on a broad set of health outcomes. We examine the literature, in terms of health outcomes, considering WASH access and interventions in urban sub-Saharan Africa from 2000 to 2017. Our review of studies which evaluate the effectiveness of specific WASH interventions, reveals an emphasis of WASH research on acute communicable diseases, particularly diarrhoeal diseases. In contrast, chronic communicable and non-communicable health outcomes were notable gaps in the literature as well as a lack of focus on cross-cutting issues, such as ageing, well-being and gender equality. We recommend a broader focus of WASH research and interventions in urban Africa to better reflect the demographic and health transitions happening.

Abbreviations: CBA: Controlled Before and After; GSD: Government Service Delivery; IWDSSD: International Drinking-Water, Supply and Sanitation Decade (IDWSSD); KAP: Knowledge, Attitudes and Practices; IBD: Irritable Bowel Diseases; MDG: Millennium Development Goals; NTD: Neglected Tropical Diseases; PSSD: Private Sector Service Delivery; SDG: Sustainable Development Goals; SSA: Sub Saharan Africa; SODIS: Solar Disinfection System; STH: Soil Transmitted Helminths; RCT: Randomised Control Trial; WASH: Water Sanitation and Hygiene; WHO: World Health Organization     

Ethnic differentials in under-five mortality in Nigeria

Objective. There are huge regional disparities in under-five mortality in Nigeria. While a region within the country has as high as 222 under-five deaths per 1000 live births, the rate is as low as 89 per 1000 live births in another region. Nigeria is culturally diverse as there are more than 250 identifiable ethnic groups in the country; and various ethnic groups have different sociocultural values and practices which could influence child health outcome. Thus, the main objective of this study was to examine the ethnic differentials in under-five mortality in Nigeria.

Design. The study utilized 2008 Nigeria Demographic and Health Survey (NDHS) data. We analyzed data from a nationally representative sample drawn from 33,385 women aged 15–49 that had a total of 104,808 live births within 1993–2008. In order to examine ethnic differentials in under-five mortality over a sufficiently long period of time, our analysis considered live births within 15 years preceding the 2008 NDHS. The risks of death in children below age five were estimated using Cox proportional regression analysis. Results were presented as hazard ratios (HR) with 95% confidence intervals (CI).

Results. The study found substantial differentials in under-five mortality by ethnic affiliations. For instance, risks of death were significantly lower for children of the Yoruba tribes (HR: 0.39, CI: 0.37–0.42, p < 0.001), children of Igbo tribes (HR: 0.58, CI: 0.55–0.61, p < 0.001) and children of the minority ethnic groups (HR: 0.66, CI: 0.64–0.68, p < 0.001), compared to children of the Hausa/Fulani/Kanuri tribes. Besides, practices such as plural marriage, having higher-order births and too close births showed statistical significance for increased risks of under-five mortality (p < 0.05).

Conclusion. The findings of this study stress the need to address the ethnic norms and practices that negatively impact on child health and survival among some ethnic groups in Nigeria.     

Hepatitis C virus infection in injection drug users in Bavaria: risk factors for seropositivity

Background: Hepatitis C Virus (HCV) infection is the most common disease among intravenous drug users (IDUs). Patients and method: All patients admitted to the detoxification unit 1991–1997 and meeting ICD-10 diagnosis of opioid dependency were tested for anti-HCV serology. Results: Thousand and forty nine patients were included in the study. About 61.3% of the IDUs were anti-HCV positive. Increasing age (PR: 1.46; 95% CI: 1.34–1.60), living with a significant other drug user (PR: 1.17; 95% CI: 1.05–1.31), history of therapy (PR: 1.62; 95% CI: 1.50–1.74), history of imprisonment (PR: 1.48; 95% CI: 1.36–1.61), history of emergency treatment (PR: 1.23; 95% CI: 1.12–1.35), additional daily consumption of benzodiazepines (PR: 1.10; 95% CI: 1.00–2.21) or alcohol (PR: 1.26; 95% CI: 1.14–1.38), frequency of injecting heroin (daily: PR: 0.86; 95% CI: 0.78–0.96; previously: PR: 1.14; 95% CI: 1.03–1.26) and type of opioid dependency (methadone: PR: 1.26; 95% CI: 1.13–1.41) were significant factors, considered as individual factors, for positive anti-HCV serology. Using multiple logistic regression we found that older age (OR: 3.54, 95% CI: 1.30–9.67), longer duration of opioid use (OR: 5.74; 95% CI: 1.82–18.13), living with a significant other drug user (OR: 1.47; 95% CI: 1.01–2.16), history of therapy (OR: 4.87; 95% CI: 1.67–14.20), history of imprisonment (OR: 1.92; 95% CI: 1.12–3.28), history of emergency treatment (OR: 1.45; 95% CI: 1.06–1.99) and additional daily consumption of alcohol (OR: 1.49; 95% CI: 1.04–2.13) remained independently associated with positive anti-HCV serology. Conclusions: These data support the need for early prevention strategies, namely, education of teachers in schools and further training of counsellors informing IDUs of what they can do to minimise the risk of becoming infected or of transmitting infectious agents to others.     

Differential inequity in health expectancy by region in Belgium

Summary. Objectives: To evaluate the size of social inequities in health between regions in Belgium using a composite health measure, the disability free life expectancy (DFLE). Methods: Mortality data (5-years follow-up of the 1991 census) are combined with the 1997 Health Interview Survey to estimate the DFLE by education. Differences in partial life expectancy_25–74 (LE_25–74) and in DFLE_25–74 between those at the bottom and those at the top of a relative social scale are used to compare the regional inequities. Results: The higher educated person has a longer LE, with more years free of disability and less years with disability (in years: Flemish males: LE = 46.48; DFLE = 42.08; Walloon males: LE = 44.92; DFLE = 39.80; Flemish females: LE = 47.90; DFLE =41.93; Walloon females: LE = 46.90; DFLE = 39.84) compared to the population at the bottom of the education hierarchy (in years: Flemish males: LE = 44.86; DFLE = 30.16; Walloon males: LE = 42.77; DFLE = 27.00; Flemish females: LE = 46.86; DFLE =28.30; Walloon females: LE = 45.44; DFLE = 25.30). The inequity in LE and in DFLE is larger in the Walloon Region than in the Flemish Region. Only the regional difference in inequity in LE is statistically significant. Conclusion: The DFLE can be used to monitor the size of health inequities. An erratum to this article is available at .     

Inhibin B in seminiferous tubules of human testes in normal spermatogenesis and in idiopathic infertility

Inhibin B is one of the most significant serum markers of spermatogenesis, but its testicular expression has been poorly studied. Inhibin B sensitivity as well as the ability to reflect the level and condition of spermatogenesis and forecast certain changes in reproductive homeostasis in males is still a subject of active discussion. The purpose of this study is to examine the level of expression of inhibin B in cells of human seminiferous tubules in normal and in pathological spermatogenesis (idiopathic infertility) by revealing the proportion of immunostaining cells for inhibin B. The research conducted included analysis of testicular tissue samples taken from 82 males diagnosed with infertility and nonobstructive azoospermia. The influence of inhibin on the germ cells of men aged 22–35 been analyzed using the immunohistochemical method. According to the obtained results, high expression of inhibin can be detected both in Sertoli (98.0 ± 2.66) and Leydig (94.0 ± 1.55) cells in patients suffering from focal spermatogenesis disorders (mixed atrophy), in comparison with the men in the control group (65.9 ± 0.44 and 12.0 ± 0.44, respectively). The level of inhibin expression in the cytoplasm of spermatogonia was 4.0 ± 0.22 in control group of fertile men, while it was significantly increased in patients with Sertoli cell-only syndrome with focal spermatogenesis (45.0 ± 0.44). In the case of severe lesion to the seminiferous tubules (e.g., tubular hyalinization), the lowest level of inhibin expression in Sertoli cells is detected, whereas the immunostaining in Leydig cells showed only slight changes. Further histological research of Sertoli cells and inhibin B expression is necessary because, according to our data, the degree of inhibin B expression may be a useful marker of Sertoli cells function which can lead to new findings in the concept of local reproductive homeostasis in testis that may be impaired in some forms of idiopathic infertility in males.

Abbreviations: β-TGF: β-transforming growth factor family; GCA: germ cell abnormalities/atypia; JS: Johnsen score; FSH: follicle stimulating hormone; TESE: testicular sperm extraction; LH: luteinizing hormone; F-Testo: free testosterone; ELISA: the enzyme-linked immunosorbent assay; CV: coefficient of variance; DR: range of definitions; AZF: azoospermia factorI; HC: immunohistochemical; HIER: heat induction of epitope retrieval; H&E: hematoxylin and eosin     

Metabolomics analysis of follicular fluid in women with ovarian endometriosis undergoing in vitro fertilization

The purpose of this study was to investigate whether a change in the follicular fluid metabolomics profile due to endometrioma is identifiable. Twelve women with ovarian endometriosis (aged<40 years, with a body mass index [BMI] of <30 kg/m²) and 12 age- and BMI-matched controls (women with infertility purely due to a male factor) underwent ovarian stimulation for intracytoplasmic sperm injection (ICSI). Follicular fluid samples were collected from both of groups at the time of oocyte retrieval for ICSI. Next, nuclear magnetic resonance (NMR) spectroscopy was performed for the collected follicular fluids. The metabolic compositions of the follicular fluids were then compared using univariate and multivariate statistical analyses of NMR data. Univariate and multivariate statistical analyses of NMR data showed that the metabolomic profiles of the follicular fluids obtained from the women with ovarian endometriosis were distinctly different from those obtained from the control group. In comparison with the controls, the follicular fluids of the women with ovarian endometriosis had statistically significant elevated levels of lactate, β-glucose, pyruvate, and valine. We conclude that the levels of lactate, β-glucose, pyruvate, and valine in the follicular fluid of the women with endometrioma were higher than those of the controls.

Abbreviations: ASRM: American Society for Reproductive Medicine; BMI: body mass index; CPMG: Carr-Purcell-Meiboom-Gill; E₂: estradiol; ESHRE: European Society of Human Reproduction and Embryology; ERETIC: electronic to access in vivo concentration; FF: follicular fluid; FSH: follicle-stimulating hormone; hCG: human chorionic gonadotropin; HEPES: 2-hydroxyethyl-1-piperazineethanesulfonic acid; ICSI: intracytoplasmic sperm injection; IVF: in vitro fertilization; NMR: nuclear magnetic resonance spectroscopy; PCA: principal component analysis; PCOS: polycystic ovary syndrome; PLS-DA: partial least squares discriminant analysis; ppm: parts per million; PULCON: pulse length-based concentration determination; TSP: 3-(trimethylsilyl)-1-propanesulfonic acid sodium salt; VIP: variable importance in projection     

Food Stabilizing Antioxidants Increase Nutrient Bioavailability in the in Vitro Model

Objective: We investigated whether antioxidants may enhance bioavailability of lipids and carbohydrates and therefore increase the risk of obesity development.

Methods: We tested how supplementation with antioxidants (0.01% butylated hydroxytoluene [BHT], α-tocopherol, and green tea catechins) of a diet containing butter and wheat bread affects bioavailability of fats and carbohydrates. The absorption of the in vitro digested diet was estimated in the intestinal epithelia model of the Caco-2 cells cultured in Transwell chambers.

Results: In the case of the antioxidant-supplemented diets, we observed increased bioavailability of glucose, cholesterol, and lipids, as well as elevated secretion of the main chylomicron protein apoB-48 to the basal compartment. Importantly, we did not detect any rise in the concentrations of lipid peroxidation products (malondialdehyde, MDA) in the control samples prepared without antioxidants.

Conclusions: Addition of antioxidants (in particular BHT) to the diet increases bioavailability of lipids and carbohydrates, which consequently may increase the risk of obesity development. The dose of antioxidants is a factor of fundamental importance, particularly for catechins: low doses increase absorption of lipids, whereas high doses exert the opposite effect.     

Cleavage-stage embryo micromanipulation in the clinical setting

Embryo micromanipulation was developed after introduction of microinjection to overcome infertility. Embryo micromanipulation may be performed at any embryo stage from pronuclear to blastocyst. The technique started out as basic and turned out to be increasingly more complex. Embryo micromanipulation at the cleavage-stage includes a wide range of techniques, from opening the zona pellucida in order to improve the chance of implantation, to removing detrimental components from the embryo to enhance embryo development or blastomeres for preimplantation genetic diagnosis and embryo splitting. Evaluating the impact(s) of different micromanipulation techniques on epigenetics of the embryo and considering quality control during these techniques are important issues in this regard. This review aims to discuss the micromanipulation of cleavage-stage embryos in clinical assisted reproductive technology (ART).

Abbreviations: ART: assisted reproductive technology; ICSI: intracytoplasmic sperm injection; IVF: in vitro fertilization; PGD: preimplantation genetic diagnosis; PZD: partial zona dissection; ZP: zona pellucida; SUZI: subzonal insemination; PVS: perivitelline space; AH: assisted hatching; LAH: laserassisted hatching; ZT: zona thinning; UV: ultraviolet; IR: infrared; PCR: polymerase chain reaction; FISH: fluorescent in situ hybridization; NGS: next generation sequencing; QC: quality control; QA: quality assurance