Browsing by Author "Laaser, Ulrich (7005289486)"

Aim: Agreeing on a Code of Ethical Conduct is an essential step in the formation and definition of a public health profession in its own right. In this paper we attempt to identify a limited number of key ethical principles to be reflected as professional guidance. Methods: We used a consensus building approach based on narrative review of pivotal literature and theoretical argumentation in search for corresponding terms and-in a second step-attempted to align them to a limited number of key values. The resulting draft code of ethical conduct was validated employing a framework of the Council of Europe and reviewed in two quasi Delphi rounds by members of a global think tank. Results: The alignment exercise demonstrated the acceptability of five preselected key principles: solidarity, equity, efficiency, respect for autonomy, and justice whereas three additional principles were identified during the discussion rounds: common good, stewardship, and keeping promises. Conclusions: In the context of emerging and re-emerging diseases as well as increase in lifestyle-related diseases, the proposed Code of Ethical Conduct may serve as a mirror which public health professionals will use to design and implement public health interventions. Future public health professional chambers or an analogous structure should become responsible for the acknowledgement and enforcement of the Code. © 2017 Laaser et al.

Aim: Agreeing on a Code of Ethical Conduct is an essential step in the formation and definition of a public health profession in its own right. In this paper we attempt to identify a limited number of key ethical principles to be reflected as professional guidance. Methods: We used a consensus building approach based on narrative review of pivotal literature and theoretical argumentation in search for corresponding terms and-in a second step-attempted to align them to a limited number of key values. The resulting draft code of ethical conduct was validated employing a framework of the Council of Europe and reviewed in two quasi Delphi rounds by members of a global think tank. Results: The alignment exercise demonstrated the acceptability of five preselected key principles: solidarity, equity, efficiency, respect for autonomy, and justice whereas three additional principles were identified during the discussion rounds: common good, stewardship, and keeping promises. Conclusions: In the context of emerging and re-emerging diseases as well as increase in lifestyle-related diseases, the proposed Code of Ethical Conduct may serve as a mirror which public health professionals will use to design and implement public health interventions. Future public health professional chambers or an analogous structure should become responsible for the acknowledgement and enforcement of the Code. © 2017 Laaser et al.

The Economic Community of West African States (ECOWAS) comprises 15-member states with an estimated population of 350 million. This account relates the present status of maternal, neonatal, and under-five-mortality to the Sustainable Development Goals (SDG) targets set for 2030. For each SDG indicator, progress observed was compared with that needed to meet the target (assuming linear progression). The time gap was calculated as the difference between the time remaining to the target year (2030) and the estimated time needed to achieve the target. The highest maternal mortality ratio is found in Sierra Leone (1360 in 2015), followed by Nigeria (814) and Liberia (725). Whereas Sierra Leone and Nigeria keep high positions also for the neonatal and under-five mortality rate, Liberia ranks clearly better than the ECOWAS average. Globally skilled health professionals‘ density is 25 per 10,000 population and in Nigeria close to it with 20.1 whereas Guinea takes the last position with 1. 4. The gap analysis shows that ECOWAS countries have a realistic chance to likely reach the SDG targets in 2030 with a delay of less than 4 years regarding maternal, neonatal, and under-five-mortality although their skilled health professionals‘ density is considerably lower than for the entire African region. © 2018, Women's Health and Action Research Centre. All rights reserved.

Background: The United Nations Assembly adopted the Sustainable Development Goals to succeed the Millennium Development Goals in September 2015. From a European perspective, the development of health in the countries of North Africa are of special interest as a critical factor of overall social development in Europe’s Mediterranean partners. In this paper, we address the mortality related SDG-3 targets, the likelihood to achieve them until 2030 and analyze how they are defined. Methods: We projected mortality trends from 2000–2015 to 2030, based on mortality estimates by inter-agency groups and the WHO in mother and child health, non-communicable diseases, and road traffic mortality. The gap analysis compares the time remaining until 2030 to the time needed to complete the target assuming a linear trend of the respective indicator. A delay of not more than 3.75 years is considered likely to achieve the target. Results: The SDG-3 targets of a Maternal Mortality Ratio below 70 per 100 000 live births and an U5MR below 25 per 1 000 live births have been achieved by Egypt, Libya, and Tunisia. Libya and Tunisia have also achieved the target for Newborn Mortality with Egypt close to achieving it as well. Algeria and Morocco are generally on track for most of the indicators, including deaths from non-communicable diseases and suicide rates; however, all of the countries are lagging when it comes to deadly Road Traffic Injuries for 2030. Mauritania is the only North African country which is not likely to reach the 2030 targets for any of the mortality indicators. Conclusions: Although mortality statistics may be incomplete there is an impressive gradient from East to West showing Mauritania and deadly road traffic injuries as the most problematic areas. Given the large differences between countries baselines, we consider it preferable to set realistic targets to be achieved until 2030. © 2019, © 2019 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

Introduction/Objective Continuing Medical Education (CME) is a crucial element to keep the level of professionalism in the three key fields of medical education: pre-clinical, clinical, and public health. The profile of CME in Serbia has been analyzed for the 2011–2017 period. Methods Between 2011 and 2017, 11,557 courses of CME have been submitted for accreditation, de-scribed by 26 variables. Due to the predominance of nominal data, we employed a principal component analysis (PCA) using the nonlinear iterative partial least squares algorithm (PCA/PLS) to arrange the 16 variables with complete information in such a way that most influential factors could be displayed and ranked. The analysis was done with TIBCO Statistical Software. Results The Faculty of Medicine of Belgrade takes the top position among the medical faculties in Serbia with 569 courses or 47.9% (n = 1187; 2011–2017), whereas non-educational institutions with 86.2% of all courses (n = 11,514) are the most dominant providers. Clinical topics dominate the thematic spectrum with 59.7%. Between 2012 and 2017, the total number of courses offered diminished by 16.9%. A PCA of 16 potential determinants of CME reveals that the most relevant ones are duration, credit points, price, and number of lecturers. Conclusion For the last decade, a standstill or even a regression in the development can be observed. Especially the faculties of medicine in Serbia, as well as other major providers, should reconsider the entire structure of their administrative organization and initiate innovative development. © 2021, Serbia Medical Society. All rights reserved.

The Albanian Forum of Public Health (AFPH), an umbrella organization including different public health associations operating in Albania, was established in March 2004 with the support of the European Public Health Association (EUPHA) and the Open Society Institute (OSI). Ever since its establishment the AFPH has been an open arena wherein opinions and options for rational health policies comprising all relevant issues of the New Public Health are discussed, formulated, and documented near the Albanian Ministry of Health. Notwithstanding the laudable mission of the AFPH, there is an emerging need to establish a regional Public Health Forum in south-east Europe as a basic prerequisite for sustainable development of public health in these countries. Most conveniently, this regional umbrella organization should have a supporting Secretariat based in one of the south-east European countries. Nevertheless, there is a clear call for international funding with participation of different agencies and bodies (OSI, EUPHA, Canadian International Development Agency, and the Stability Pact). A regional association in the south-east Europe would enable the organization of annual conferences in the most renowned institutions in the region. Also, a regional collaboration among public health associations would be a suitable start for the development of research in south-east Europe. Furthermore, the existence of a regional public health association would make feasible the establishment of a scientific public health journal for south-east Europe in the English language. © The Author 2006. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Aim: This study reviews the ability of the Russian Federation to reduce the high mortality until 2030 evenly across the country and in accordance with the Sustainable Development Goals (SDG). Methods: We adopted the method suggested by Haenszel for estimating Premature Years of Life Lost for the age group <70 years and applied a projected reduction of 33% by 2030 as proposed for SDG 3.4. To calculate the potential time gap we used the model of the United Nations Development Programme and standardized the rates by the OECD 1980 Standard Population employing the direct method. Results: If Russia keeps the present level of effort the reduction by one third of the level of premature mortality as in 2013 will be in reach already in 2024 i.e. 5.9 years in advance of the SDG 3 target for 2030. This target is achieved quite evenly also throughout the 8 districts of the Russian Federation between 10.6 and 5.0 years in advance and in selected special districts/republics with the highest and lowest mortality rates. Conclusion: After the steep decrease of life expectancy during the 1990ies the Russian Federation returned to the original trajectory. © 2020 Chernyavskiy et al.

Aim: This study reviews the ability of the Russian Federation to reduce the high mortality until 2030 evenly across the country and in accordance with the Sustainable Development Goals (SDG). Methods: We adopted the method suggested by Haenszel for estimating Premature Years of Life Lost for the age group <70 years and applied a projected reduction of 33% by 2030 as proposed for SDG 3.4. To calculate the potential time gap we used the model of the United Nations Development Programme and standardized the rates by the OECD 1980 Standard Population employing the direct method. Results: If Russia keeps the present level of effort the reduction by one third of the level of premature mortality as in 2013 will be in reach already in 2024 i.e. 5.9 years in advance of the SDG 3 target for 2030. This target is achieved quite evenly also throughout the 8 districts of the Russian Federation between 10.6 and 5.0 years in advance and in selected special districts/republics with the highest and lowest mortality rates. Conclusion: After the steep decrease of life expectancy during the 1990ies the Russian Federation returned to the original trajectory. © 2020 Chernyavskiy et al.

Objectives: The Government of Liberia has set ambitious national health targets for 2021 to reduce the high maternal, newborn, and child mortality rate and to improve the related health services. Additionally, Sustainable Development Goal 3 provides a long-term target for 2030. The objective of this article is to analyze the gaps between the targets and collected data. Materials and Methods: Relevant national documents were scrutinized to identify targets and related indicators which can serve as benchmarks for future achievements in Liberia's maternal, newborn, and child health. For each indicator, progress observed will be compared with that needed to meet the target, based on the indicator value in a baseline year, a later observed value, and the expected value in 2021 and 2030, respectively. Results: The Gap Analysis reveals achievements and serious delays for 21 health and health system indicators. Based on national data the reduction of the maternal mortality ratio will take an additional −8.2 years for the 2021 target and −12.5 years for the 2030 target. The Neonatal Mortality rate is experiencing similar delays of −7.9 years for 2021 and −12.9 for 2030 whereas the targets for the Under-5-Mortality rate can be achieved with small delays of −1.8 and −1.7 years. Conclusions: The Government of Liberia requires persistent efforts and international support to achieve its national targets and the Sustainable Development Goal 3 for health. © Copyright © 2019 Laaser, Broniatowski, Byepu and Bjegovic-Mikanovic.

Background: The most important instrument of EU support for the reforms of higher education in the European countries with the final goal of joining the European Higher Education (HE) Area by the year 2010 is TEMPUS (Trans-European Mobility Programme for University Studies). So far, Tempus is the only EU programme providing support for the reform of HE in the Western Balkans. Aim The purpose of this paper is to present the new curriculum of the Master of Health Policy and Management programme, which will provide students in Serbia with the up-to-date knowledge and necessary skills to analyse options, define strategies, formulate and implement health policies, and manage solutions for the effective delivery of health services. Methods: With financial support from the European Union's Tempus project, the "Postgraduate Study in Public Health Sciences" core project team from the Centre School of Public Health (C-SPH) School of Medicine (SoM) in Belgrade, supported by European project partners from Dresden, Rome and Krakow, developed a new curriculum-the Master of Health Policy and Management (MHPM) programme. Project activities (courses, workshops and visits to partner institutions) took place in Belgrade, Dresden, Rome and Krakow throughout 2006-2009. Results: The MHPM programme, based on modular principles and a European Credit Transfer System (ECTS) approach (60 ECTSs), was established at the C-SPH SoM and approved by the University of Belgrade. The MHPM programme consists of two tracks: one for health-care services management and the other for public health management. The first generation of MHPM students enrolled at the C-SPH SoM, Belgrade, in September 2008. They successfully passed all obligatory courses. It is envisaged that the first MHPM students will graduate in autumn/winter 2009. Conclusion: We believe that the project will continue to deliver benefits to the project beneficiaries after the Commission's financial assistance has been terminated. The MHPM programme will facilitate health-care administration reform, contribute to strengthening civil society and accelerate the development of democracy and the rule of law through good governance in Serbia. © Springer-Verlag 2009.

Objectives: To assess the exit competences of public health graduates across a diverse European landscape. Methods: The target population comprised 80 full institutional members of the Association of Schools of Public Health in the European Region with a participation rate 82.5 %. The web-based questionnaire covered institutional profiles and the ranking of exit competences for master of public health programmes, grouped according to WHO Essential Public Health Operations. Results: European schools and departments usually are small units, funded from tax money. A total of 130 programmes have been indicated, together releasing 3,035 graduates in the last year before the survey. All competence groups showed high reliability and high internal consistency (α > 0.75, p < 0.01). The best teaching output has been assessed for health promotion, followed by disease prevention and identification of health hazards in the community, the least in emergency preparedness. Conclusions: Given the fragmentation of the institutional infrastructure, the harmonisation of programme content and thinking is impressive. However, the educational capacity in the European Region is far from being sufficient if compared to aspired US levels. © 2012 Swiss School of Public Health.

Objective: To describe the prevalence of intimate partner violence and associated factors among married women in Albania. Design: Cross sectional study. Setting: Tirana, the capital city of Albania. Participants: A representative sample of 1039 married women aged 25-65 living in Tirana and recorded in the 2001 census. Methods: Questionnaire on intimate partner violence and social and demographic characteristics of the women and their husbands. Main outcome measure: Women's experience within the past year of being hit, slapped, kicked, or otherwise physically hurt by the husband. Results: More than a third (37%, 384/1039) of women had experienced violence. Risk was greatest among women aged 25-34 (odds ratio 1.47, 95% CI 1.04 to 2.09), women with tertiary education (3.70, 2.04 to 6.67), women in white collar jobs (4.0,1.59 to 10.0), women with least educated husbands (5.01, 2.91 to 8.64), and women married to men raised in rural areas (3.31, 2.29 to 4.80). Women were at higher risk if they were more educated than their husbands (4.76, 2.56 to 9.09). Conclusions: In transitional Albania, the risk of spousal violence is high, and more empowered women are at greater risk.

Aim This manuscript deals with public health training, research and practice in order to identify the future perspectives and requirements of master's programmes in public health sciences in Serbia. Methods: A wide array of documents and websites was analysed. The methods used for data collection were: (1) review of the existing written reports, the relevant legislation and other documents, and (2) Internet searches accessing the websites of the Ministries of Health, Education, Science and Technology of the Republic of Serbia as well as websites covering thematic areas in European and global education, research and development. Use has also been made of the results of the European Union projects done in the field of public health in Serbia, particularly the Tempus programme "Postgraduate Studies in Public Health Sciences". Results: The most important role in the field of change in public health in Serbia is played by the School of Public Health (SPH) and the Institutes of Public Health (IPH). Although at the managerial level the need for change has been perceived, in general there is not a shared, clear vision of what the change should be and how this should happen. The reorganisation of the IPH in Serbia is greatly needed given their poor present performance and the expectations of the government to reach EU standards and to increase the health status of the Serbian population. The main obstacles are seen to be inappropriate legislation, lack of financial resources and insufficiently trained staff. Three areas with priority for future development have been identified: (1) doctoral programmes in public health and in health policy and management, (2) expansion of continuing and life-long learning in good governance and public health management, and (3) increasing the research base in public health and management. Conclusion: The need for a better trained workforce in the fields of public health, health management and health promotion is clearly recognised by public health professionals in Serbia. Therefore, the educational infrastructure should be amended by doctoral programmes and life-long learning schemes, based on intensified public health research. © Springer-Verlag 2009.

Aim: Over the past two decades, two catastrophic events caused a steep decline in health services in Liberia: the long-lasting civil war (1989-2003) and the weak response of the health system to the Ebola Viral Disease (EVD) outbreak (2013-2015). In early 2015 The Liberian Government reacted and developed a strategic health policy framework. This paper reviews that framework with a focus on maternal and newborn health. Methods: The study is designed as a narrative review executed during the second half of 2017 in Monrovia. It takes advantage of triangulation, derived from recent international and national documents, relevant literature, and available information from primary and secondary sources and databases. Results: In 2015 the severely compromised health system infrastructure included lack of functional refrigerators, low availability of vaccines and child immunization guidelines, high stock-out rates, and an absence of the cold chain minimum requirements in 46% of health facilities. The public health workforce on payroll during 2014/15 included only 117 physicians. Skilled birth attendance as an indicator of maternal health services performance was 61%. Presently, approximately 4.5 women die each day in Liberia due to complications of pregnancy, delivery, and during the post-partum period, equalling about 1,100 women per 100,000 live births. Of particular note is the adolescent birth rate of 147 per 1000 women aged 15-19 years, three times higher than the world average of 44. Additionally, with a neonatal mortality rate of 19.2 neonatal deaths per 1,000 live births, Liberia stands higher than the world average as well. The high mortality rates are caused by multiple factors, including a delay in recognition of complications and the need for medical care, the time it takes to reach a health facility due to a lack of suitable roads and transportation, and a delay in receiving competent care in the health facilities. Conclusions: The fact that performance is above average for some indicators and far below for other points to unexplained discrepancies and a mismatch of international and national definitions or validity of data. Therefore, it is recommended to concentrate on the core of tracer indicators adopted at the global level for Universal Health Coverage and the Sustainable Development Goals to enable a permanent update of relevant information for policymaking and adjustment. At present all health policy documents miss a thorough application of the SMART objectives (Specific, Measurable, Attainable, Relevant and Timely), notably missing in most documents are realistic and detailed budgeting and obligatory timelines for set targets. © 2019 Bjegovic-Mikanovic et al.

Aim: Over the past two decades, two catastrophic events caused a steep decline in health services in Liberia: the long-lasting civil war (1989-2003) and the weak response of the health system to the Ebola Viral Disease (EVD) outbreak (2013-2015). In early 2015 The Liberian Government reacted and developed a strategic health policy framework. This paper reviews that framework with a focus on maternal and newborn health. Methods: The study is designed as a narrative review executed during the second half of 2017 in Monrovia. It takes advantage of triangulation, derived from recent international and national documents, relevant literature, and available information from primary and secondary sources and databases. Results: In 2015 the severely compromised health system infrastructure included lack of functional refrigerators, low availability of vaccines and child immunization guidelines, high stock-out rates, and an absence of the cold chain minimum requirements in 46% of health facilities. The public health workforce on payroll during 2014/15 included only 117 physicians. Skilled birth attendance as an indicator of maternal health services performance was 61%. Presently, approximately 4.5 women die each day in Liberia due to complications of pregnancy, delivery, and during the post-partum period, equalling about 1,100 women per 100,000 live births. Of particular note is the adolescent birth rate of 147 per 1000 women aged 15-19 years, three times higher than the world average of 44. Additionally, with a neonatal mortality rate of 19.2 neonatal deaths per 1,000 live births, Liberia stands higher than the world average as well. The high mortality rates are caused by multiple factors, including a delay in recognition of complications and the need for medical care, the time it takes to reach a health facility due to a lack of suitable roads and transportation, and a delay in receiving competent care in the health facilities. Conclusions: The fact that performance is above average for some indicators and far below for other points to unexplained discrepancies and a mismatch of international and national definitions or validity of data. Therefore, it is recommended to concentrate on the core of tracer indicators adopted at the global level for Universal Health Coverage and the Sustainable Development Goals to enable a permanent update of relevant information for policymaking and adjustment. At present all health policy documents miss a thorough application of the SMART objectives (Specific, Measurable, Attainable, Relevant and Timely), notably missing in most documents are realistic and detailed budgeting and obligatory timelines for set targets. © 2019 Bjegovic-Mikanovic et al.

The modern concept of public health, the New Public Health, carries a great potential for healthy and therefore less aggressive societies. Its core disciplines are health promotion, environmental health, and health care management based on advanced epidemiological methodologies. The main principles of living together in healthy societies can be summarized as four ethical concepts of the New Public Health essential to violence reduction - equity, participation, subsidiarity, and sustainability. The following issues are discussed as violence's determinants: the process of urbanization; type of neighborhood and accommodation, and consequent stigmatization; level of education; employment status; socialization of the family; women's status; alcohol and drug consumption; availability of the firearms; religious, ethnic, and racial prejudices; and poverty. Development of the health systems has to contribute to peace, since aggression, violence, and warfare are among the greatest risks for health and the economic welfare. This contribution can be described as follows: 1) full and indiscriminate access to all necessary services, 2) monitoring of their quality, 3) providing special support to vulnerable groups, and 4) constant scientific and public accountability of the evaluation of the epidemiological outcome. Violence can also destroy solidarity and social cohesion of groups, such as family, team, neighborhood, orany other social organization. Durkheim coined the term "anomie" for a state in which social disruption of the community results in health risks for individuals. Health professionals can make a threefold contribution to peace by 1) analyzing the causal interrelationships of violence phenomena, 2) curbing the determinants of violence according to the professional standards, and 3) training professionals for this increasingly important task. Because tolerance is an essential part of an amended definition of health, monitoring of the early signs of public intolerance is important. The vital interplay between the informed public and efficient administration, however, can only exist in an open society. The link between democracy and health of the people, and between public health and economic welfare is real. The Public Health Collaboration in South Eastern Europe (PH-SEE) evolved just in time to reconnect and strengthen disrupted professional networks in the region as a prerequisite of effective public health action.

It is argued that each country of South Eastern Europe should have its own school of public health. However, a basic prerequisite of modern public health training is the comprehensiveness of the programme and a worldview approach. Most of the countries of South Eastern Europe face the same difficulties to adapt their inherited communist structures of public health training to Western standards. A regional collaboration would facilitate the process of establishing schools of public health in all countries of the region and support the training of public health professionals at all levels. Key Points asterisk inside a circle sign South East Europe includes Albania, Bosnia and Herzegovina, Bulgaria, Croatia, Greece, Macedonia, Moldavia, Romania, Serbia and Montenegro, and Slovenia. asterisk inside a circle sign Public health institutions in South East Europe face similar difficulties to adapt their inherited teaching structures to Western standards. asterisk inside a circle sign Public health institutions in South East Europe should make a joint effort towards establishing regional training programmes. asterisk inside a circle sign A regional approach in public health training would enable an efficient use of resources in countries of South East Europe. © European Public Health Association 2005; all rights reserved.

Background: European Essential Public Health Operations (EPHOs) supposedly drive improvements in public health outcomes, including Schools and Departments of Public Health (SPHs). Overall, SPHs did not progress significantly in delivering outcomes related to the EPHOs between 2011 (Survey I) and 2015/16 (Survey II). This analysis attempts to identify the positive or negative development of individual SPHs. Methods: The analysis has utilized data obtained from SPHs through questionnaire-based surveys, which contained information about learning outcomes of Master of Public Health (MPH) programs necessary for the implementation of EPHOs. To differentiate the progress of SPHs, we applied cluster analyses for a group of 36 SPHs with complete data sets for both surveys. Results: The statistical analysis identified three clusters for Survey I and Survey II, defined by their medians and position vectors. A comparison shows that between the two surveys, all clusters overlap and thus are not significantly different. Of the individual SPHs, 16 of 36 (44.4%) improved between 2011 and 2015/16 according to the increased magnitude of their position vector, whereas 9 SPHs (25.0%) show significant progress at P<0.05. From the 20 SPHs (55.6%) that decreased their performance, 11 (30.6%) showed a significant reduction in the outcome of Master of Public Health programs at P<0.05. This outcome implies that N=20 or 55.6% of the participating SPHs evidenced substantial changes. Analysis of 11 available nominal variables did not significantly explain the cluster positions in Survey I and II. Conclusions: Overall, there is no significant progress in the performance of SPHs between 2011 and 2015/16. However, detailed cluster analysis can demonstrate considerable progress for one-fifth of participating SPHs, whereas more than half lag. © Journal of Public Health and Emergency. All rights reserved.

[No abstract available]

[No abstract available]