[The career of medical public health specialists graduated from the French public health medical residency]. / La carrière des médecins spécialistes de santé publique et médecine sociale titulaires du diplôme d'études spécialisées.

BACKGROUND: The French public health medical residency was created in 1984 to train medical public health specialists. Knowledge was lacking on the career of the trained practitioners, with the sole study dating from 1995. In this study, the French national association of medical public health residents aimed to describe the training and career of all medical public health specialists since the inception of the residency. METHODS: An online survey took place during the first semester of 2012 to collect information on all medical public health specialists graduated from the French public health medical residency. Descriptive analysis of the collected information was performed. RESULTS: Replies from 563 graduated medical public health residents were collected from all over the country and years since the inception of the training. Ninety-eight percent of the informants were in activity. They mostly worked in public healthcare facilities (56%) and public administration (16%). Their main areas of practice were: epidemiology, clinical research, biostatistics (37%); health management information system (19%); health policy (14%). Eighty-eight percent of the respondents held a master degree, 29% a PhD. Practical training during the medical residency was deemed as very useful or needed by 73% of the informants, theoretical training by 43%. Sixty-eight percent of informants were very or fully satisfied by their carrier, 29% rather satisfied. CONCLUSION: This is the first study to achieve coverage of more than 45% of all medical public health specialists graduated since the inception of the public health medical residency. Full employment, wide-range activities, evolving carriers can explain the high satisfaction rates. The public health medical residency being the main access point to the public health medical specialty, the impact of the initial training on the career should lead to rethink the design of the public health medical residency to fulfil the needs in the public health sector.

[Social Security Needs Social Medicine: Self-image of Physicians Practicing Social Medicine in Statutory Health Insurances and Social Security Systems]. / Soziale Sicherheit braucht Sozialmedizin Selbstverständnis von Ärztinnen und Ärzten in der sozialmedizinischen Begutachtung und Beratung.

OBJECTIVE: In January, 2014, the division "Social Medicine in Practice and Rehabilitation" of the German Society for Social Medicine and Prevention established a working group on the self-image of the physicians active in the field of social medicine (medical expertise and counseling). METHODS: The result of this work is the contribution presented here after consensus was achieved by specialists of social medicine from different fields and institutions (social security etc.) and in good cooperation with Prof. Dr. Gostomzyk and Prof. Dr. Robra. RESULTS: Based on the importance of an up to date social medicine for claimants and recipients of benefits on the one hand and the social security system on the other, and also on a description of the subjects, objectives and methods the following aspects are presented: · The perspective of social medicine. · Qualification in social medicine, concerning specialist training and continuing medical education. · The fields of duty of experts in social medicine. · The proceedings in social medicine. The working group identified challenges for the specialists in social medicine by a narrowed perception of social medicine by physicians in hospitals and practice, accompanied by an enlarged importance of expertise in social medicine, by the demand for more "patient orientation" and gain of transparency, and concerning the scientific foundation of social medicine. CONCLUSIONS: The working group postulates: · The perspective of social medicine should be spread more widely.. · Confidence in experts of social medicine and their independency should be strengthened.. · The not case-related consulting of the staff and executives should be expanded.. · Social medicine in practice needs support by politics and society, and especially by research and teaching.. · Good cooperation and transfer of experiences of the different branches of social security are essential for the impact of social medicine..

Health Related Quality of Life in a Sample of Older People who are Members of Open Care Centers for the Elderly.

The consequences of demographic ageing, demographic and social-economic changes, changes in the structure of family, in the shrinkage of Welfare state, influenced the lifestyle of the older people and their social relations. The institution of Open Care Centers for the Elderly (KAPI) was created in the context of these conditions. This cross-sectional study examined the lifestyle of the older people who are member of KAPI and their association with all HRQoL dimensions. The results of this research showed that the main reason for the participants to become members of the KAPI was entertainment and/or companionship (98.4%). Additionally subjects who suffered from a chronic disease had significantly lower scores on all HRQoL dimensions, while participants who were members in the activity groups of KAPI had significantly higher scores. The elderly within the KAPI have many opportunities to meet with other persons of their age, and develop various activities and interests.

Sanitary conditions of abattoirs in Ibadan, Southwest Nigeria.

BACKGROUND: The environment in the abattoir is of public health concern because of its implications on the quality of meat sold in the markets. The poor sanitary states of abattoirs have been reported in the literature. Very few studies have provided a comprehensive assessment of the sanitary conditions in the abattoir premises. This study sought to assess the compliance of abattoirs in Ibadan, Southwest Nigeria with standards set by Federal Ministry of Environment. METHODOLOGY: A descriptive cross-sectional study was conducted in Ibadan using an observational checklist adapted from Policy guidelines on market and abattoir sanitation by the Federal Ministry of Environment. Twelve (12) abattoirs in Ibadan metropolis were assessed. Data obtained were analyzed using descriptive statistics. RESULTS: Concerning general inspection, only one (8.3%) of the abattoirs had adequate access route, potable water supply and functional drainage system. Many had poor solid waste management practices as heaps of refuse littered the surroundings. Internal inspection of the abattoirs revealed that two (16.7%) had adequate space and facilities. Ten (83.3%) had first aid posts even though they were not equipped with materials. Eleven (91.7%) abattoirs had toilet facilities that were either poorly kept or abandoned. CONCLUSION: This study showed that most of the abattoirs in Ibadan metropolis were operating under unhygienic and sub-standard conditions and lacked basic requirements for a good abattoir as stipulated in the Policy Guidelines on Market and Abattoir Sanitation. There is an urgent need to enforce the minimum standards as stipulated in the policy guidelines.

Evaluation of the project P.A.T.H.S. based on students' weekly diaries: findings from eight datasets.

This paper aims to investigate the effectiveness of the Tier 1 Program of the Project P.A.T.H.S. (positive adolescent training through holistic social programmes) based on eight datasets collected between 2005 and 2009. A total of 1,138 students who participated in the program were randomly invited (from the whole grade or in some classes) to write a piece of journal in the form of a weekly diary in order to reveal their perceptions and feelings regarding the program and the perceived benefits of the program. Based on an integration of findings from different databases, results showed that the respondents generally (1) had positive views on the program, (2) had positive views on the instructors, and (3) perceived that they had acquired competencies at the societal, school, familial, interpersonal, and personal levels after joining the program. Acknowledging the limitations of diaries, the present qualitative findings provide support for the effectiveness of the Tier 1 Program of the Project P.A.T.H.S. in Hong Kong.

Evaluation of a positive youth development program based on the repertory grid test.

The repertory grid test, based on personal construct psychology, was used to evaluate the effectiveness of Project P.A.T.H.S. (Positive Adolescent Training through Holistic Social Programmes) in Hong Kong. One hundred and four program participants (n = 104) were randomly invited to complete a repertory grid based on personal construct theory in order to provide both quantitative and qualitative data for measuring self-identity changes after joining the program. Findings generally showed that the participants perceived that they understood themselves better and had stronger resilience after joining the program. Participants also saw themselves as closer to their ideal selves and other positive role figures (but farther away from a loser) after joining the program. This study provides additional support for the effectiveness of the Tier 1 Program of Project P.A.T.H.S. in the Chinese context. This study also shows that the repertory grid test is a useful evaluation method to measure self-identity changes in participants in positive youth development programs.

[Social medicine in medical faculties: realisation of the topic in the specialty "social medicine, occupational health"]. / Sozialmedizin an medizinischen Fakultäten: Realisierung des Teilbereichs im Fach "Sozialmedizin, Arbeitsmedizin".

PURPOSE OF THE STUDY: The 9 (th) Revision of German Medical Licensing Regulations for Physicians has come into effect on October 1 (st) 2003. Social medicine was separated into the fields ""occupational health, social medicine" and the various cross-sectional modules: epidemiology, biometry, medical computer science; health economics, health-care system, public health; prevention, health promotion; rehabilitation, physical medicine, naturopathic treatment. This paper studies the realisation of teaching in the field social medicine at German medical faculties. METHODS: The survey was conducted in collaboration with the German Association for Social Medicine and Prevention (DGSMP). A survey was conducted at 38 institutes of 36 German medical faculties. The written questionnaire contained mostly selection items in which chances and barriers of the field were queried with supply items. Information about time scale, general conditions and resources was aked for. On the basis of the guidelines of the DGSMP, the topics to be taught were evaluated concerning their relevance and integration into education. RESULTS: The response rate was 68% (n=26). Social insurance, basic principles, responsibility in the Social Security Code and the different providers were judged as the most important topics. There was a strong demand for lecturing material. 82% (n=18) of the faculties wished to have specific material, for example e-learning, examples, lesson plans, curricula and also textbooks. 91% (n=19) of the faculties requested an exchange of information between the faculties concerning educational contents, motivation of students and e-learning. DISCUSSION: The realisation of teaching is different between the faculties concerning the number of hours, teaching methods and number of students per year. The motivation of the students is one of the problems, but also the lack of acceptance within the clinic. Specific resources and exchange between the faculties are necessary concerning e-learning, which is offered at only few faculties so far, but interest for a more intensive usage exists. Potentials of social medicine are the promotion of awareness among the students and the "identification of basics for medical acts in the social security system". Social medicine offers the possibility to connect the theoretical institutes with the clinic.

Individual and collective bodies: using measures of variance and association in contextual epidemiology.

BACKGROUND: Social epidemiology investigates both individuals and their collectives. Although the limits that define the individual bodies are very apparent, the collective body's geographical or cultural limits (eg "neighbourhood") are more difficult to discern. Also, epidemiologists normally investigate causation as changes in group means. However, many variables of interest in epidemiology may cause a change in the variance of the distribution of the dependent variable. In spite of that, variance is normally considered a measure of uncertainty or a nuisance rather than a source of substantive information. This reasoning is also true in many multilevel investigations, whereas understanding the distribution of variance across levels should be fundamental. This means-centric reductionism is mostly concerned with risk factors and creates a paradoxical situation, as social medicine is not only interested in increasing the (mean) health of the population, but also in understanding and decreasing inappropriate health and health care inequalities (variance). METHODS: Critical essay and literature review. RESULTS: The present study promotes (a) the application of measures of variance and clustering to evaluate the boundaries one uses in defining collective levels of analysis (eg neighbourhoods), (b) the combined use of measures of variance and means-centric measures of association, and (c) the investigation of causes of health variation (variance-altering causation). CONCLUSIONS: Both measures of variance and means-centric measures of association need to be included when performing contextual analyses. The variance approach, a new aspect of contextual analysis that cannot be interpreted in means-centric terms, allows perspectives to be expanded.

Evaluation of Project P.A.T.H.S. in Hong Kong: utilization of student weekly diary.

Four schools participating in the experimental implementation phase of the Project P.A.T.H.S. (Positive Adolescent Training through Holistic Social Programmes) (Secondary 1 level) were randomly selected and invited to join this research study. After completion of the Tier 1 Program, Secondary 1 students in the participating schools were invited to write a reflective journal in the form of a weekly diary in order to reveal their perceptions and feelings regarding the Tier 1 Program and the related benefits. Results of the qualitative data analyses showed that most of the respondents (a) had positive views on the program, (b) had positive views on the instructors, and (c) stated that they had acquired competencies at societal, familial, interpersonal, and personal levels after joining the program. The present qualitative findings based on students' weekly diaries provide additional support for the effectiveness of the Tier 1 Program of P.A.T.H.S. in Hong Kong.

Evaluation of the Tier 1 Program of Project P.A.T.H.S.: secondary data analyses of conclusions drawn by the program implementers.

The Tier 1 Program of the Project P.A.T.H.S. (Positive Adolescent Training through Holistic Social Programmes) is a curricula-based positive youth development program. In the experimental implementation phase, 52 schools participated in the program. Based on subjective outcome evaluation data collected from the program participants (Form A) and program implementers (Form B) in each school, the program implementers were invited to write down five conclusions based on an integration of the evaluation findings (N = 52). The conclusions stated in the 52 evaluation reports were further analyzed via secondary data analyses in this paper. Results showed that most of the conclusions concerning perceptions of the Tier 1 Program, instructors, and effectiveness of the programs were positive in nature. There were also conclusions reflecting the respondents' appreciation of the program. Finally, responses on the difficulties encountered and suggestions for improvements were observed. In conjunction with the previous evaluation findings, the present study suggests that the Tier 1 Program was well received by the stakeholders and the program was beneficial to the development of the program participants.

Process evaluation of the Tier 1 Program (Secondary 1 Curriculum) of the Project P.A.T.H.S.: findings based on the full implementation phase.

To understand the implementation quality of the Tier 1 Program (Secondary 1 Curriculum) of the Project P.A.T.H.S. (Positive Adolescent Training through Holistic Social Programmes), observers carried out process evaluation in the form of systematic observations of 22 units in 14 randomly selected schools. Results showed that the overall level of program adherence was generally high (range: 45-100%, with an average of 86.3%). High implementation quality of the program in the areas of student interest, student participation and involvement, classroom control, use of interactive delivery method, use of strategies to enhance student motivation, use of positive and supportive feedbacks, instructors' familiarity with the students, degree of achievement of the objectives, time management, lesson preparation, overall implementation quality, and success of implementation was also found. The present findings are consistent with those observations based on the experimental implementation phase, suggesting that the implementation quality of the Tier 1 Program (Secondary 1 Curriculum) was generally high.

Interim evaluation of the Secondary 2 Program of Project P.A.T.H.S.: insights based on the experimental implementation phase.

An interim evaluation was conducted to understand the implementation quality of the Tier 1 Program (Secondary 2 Curriculum) of the Project P.A.T.H.S. (Positive Adolescent Training through Holistic Social Programs) in the Experimental Implementation Phase. Twenty-five schools were randomly selected to participate in personal and/or telephone interviews to provide information on the implementation details of the program and perceived attributes of the worker-support scheme ("Co-Walker Scheme"). Results showed that a majority of the workers perceived that the students had positive responses to the program and the program was helpful to the students. They also identified several good aspects in the program and the Co-Walker Scheme, albeit expressing some negative comments on the program design and difficulties in the implementation process. In conjunction with other findings reported previously, the present findings suggest that the Tier 1 Program is well received by different stakeholders and it promotes the positive development of secondary school students in Hong Kong.

Interim evaluation of the Tier 1 Program (Secondary 1 Curriculum) of the Project P.A.T.H.S.: first year of the full implementation phase.

To understand the implementation quality of the Tier 1 Program (Secondary 1 Curriculum) of the Project P.A.T.H.S. (Positive Adolescent Training through Holistic Social Programmes) in the full implementation phase, 100 schools were randomly selected to participate in personal and/or telephone interviews regarding the quality of the implementation process of the Tier 1 Program. In the interviews, the participants described the responses of the students to the program, the perceived benefits of the program, the perceived good aspects of the program, and the areas requiring improvement, difficulties encountered in the implementation process, and perceived attributes of the worker-support scheme ("Co-Walker Scheme"). Results showed that most workers perceived that the students had positive responses to the program and the program was beneficial to the students. They also identified several good aspects in the program, although negative comments on the program design and difficulties in the implementation process were also recorded. Roughly half of the respondents had positive comments on the "Co-Walker Scheme". In sum, the respondents generally regarded the program as beneficial to the students and they were satisfied with the Tier 1 Program (Secondary 1 Curriculum) in the full implementation phase, although some implementation difficulties were also expressed.

Positive youth development programs targeting students with greater psychosocial needs: subjective outcome evaluation.

The Tier 2 Program of the Project P.A.T.H.S. (Positive Adolescent Training through Holistic Social Programmes) targets adolescents with greater psychosocial needs, and the related programs were designed and implemented by school social workers. After completion of the Tier 2 Program, 2,173 students in 52 schools responded to the Subjective Outcome Evaluation Form (Form C), assessing their views of the program, instructors, and perceived effectiveness of the program. Based on the consolidated reports submitted by the agencies to the funding body, the research team aggregated the consolidated data to form a "reconstructed" overall profile of the perceptions of the program participants. Four major types of program were identified, including programs based on the adventure-based counseling approach (N = 8), programs concentrated on volunteer training and services (N = 7), programs incorporating both adventure-based counseling and volunteer training elements (N = 30), and other programs with different foci (N = 7). Results showed that high proportions of the respondents had positive perceptions of the programs and the instructors, and roughly four-fifths of the respondents regarded the program as helpful to them. The present study provides support for the effectiveness of the Tier 2 Program of P.A.T.H.S. in Hong Kong for the experimental implementation phase.

Process evaluation of the implementation of the Secondary 2 Program of Project P.A.T.H.S. in the experimental implementation phase.

This study aimed to understand the implementation quality of the Tier 1 Program (Secondary 2 Curriculum) delivered in the Experimental Implementation Phase of the Project P.A.T.H.S. (Positive Adolescent Training through Holistic Social Programmes). Observers carried out process evaluation in the form of systematic observations of curriculum units in four randomly selected schools. Results showed that the overall level of program adherence was generally high, ranging from 70 to 95%, with an average of 83.6%. The mean ratings of the program implementation quality were high, and the inter-rater reliability on these ratings across the observers was highly reliable. Despite limitations, the findings of this study suggest that the implementation quality of the Secondary 2 Program (Tier 1 Program) of the Experimental Implementation Phase was favorable, and provide supporting evidence to account for the successful and encouraging outcomes of a major positive youth development program in Hong Kong.

Gender differences in self-reported morbidity: evidence from a population-based study in southern Brazil / Diferenças na morbidade referida entre sexos: evidências de um estudo de base populacional no Sul do Brasil

This paper aims to assess variations in self-reported morbidity between men and women using six different measures of reported illness. The cross-sectional study was conducted in the municipality of Rio Grande, southern Brazil. Demographic, socioeconomic, and morbidity data were collected from a probabilistic sample of 1,260 persons aged 15 years or over, using a specific questionnaire. Statistical analysis included a multivariate Poisson regression analysis. Prevalence Ratios (PR) with 95 percent confidence intervals (95 percentCI) were calculated. After adjusting for some confounding variables (age, race, unemployment, marital status, income, social class, and education), women showed greater risk of any symptom (PR = 3.21; 95 percentCI: 2.71-3.83), three or more symptoms (PR = 4.22; 95 percentCI: 2.97-5.98), potentially serious symptoms (PR = 1.75; 95 percentCI: 1.31-2.34), poor/fair health (PR = 1.78; 95 percentCI: 1.37-2.32), and minor psychiatric disorders (PR = 1.76; 95 percentCI: 1.31-2.37). The study revealed dissimilarity in self-reported morbidity between men and women in southern Brazil, but with different degrees depending on type of morbidity. This excess can be explained by gender difference in health-seeking behavior for perceiving or reporting health problems.

O estudo teve como objetivo avaliar que diferenças ocorrem na morbidade referida entre homens e mulheres, utilizando seis medidas diferentes de morbidade. O estudo de tipo transversal foi realizado no Município de Rio Grande, Sul do Brasil. Foram coletados dados demográficos, sócio-econômicos de uma amostra probabilística de 1.260 pessoas com 15 anos ou mais. Para fins estatísticos foi utilizada a regressão de Poisson. Após ajustar para variáveis de confusão, observou-se que as mulheres apresentavam maior risco de referir um sintoma (RP = 3,21; IC95 por cento: 2,71-3,83), de ter três ou mais sintomas (RP = 4,22; IC95 por cento: 2,97-5,98), de ter um sintoma potencialmente sério (RP = 1,75; IC95 por cento: 1,31-2,34), de apresentar uma percepção do estado de saúde pobre ou regular (RP = 1,78; IC95 por cento: 1,37-2,32) e de sofrer de distúrbios psiquiátricos menores (RP = 1,76; IC95 por cento: 1,31-2,37). O estudo aponta para a existência de diferenças entre os sexos na morbidade referida, mas com magnitudes diferentes conforme o tipo de medida de morbidade utilizada. Este excesso pode ser explicado pelas variações que ocorrem no comportamento na procura de cuidados em saúde (percepção e/ou informação de problemas de saúde) entre mulheres e homens.

[Strategic controlling in the consideration of social demographic changes in social medical services]. / Strategisches Controlling zur Berücksichtigung des soziodemographischen Wandels in einem sozialmedizinischen Dienst.

Annually the Medizinische Dienst der Krankenversicherung Westfalen-Lippe (MDK-WL) performs approximately 120,000 nursing care assessments according to the 11th social statute book (SGB XI). A prospective reflection on the amount of expert assessments and the spectrum of services for the Nursing Care Insurance until 2020, was performed in order to establish a long term strategic controlling. The insured party makes the request for nursing care according to their personal estimation when the need for assistance is increasing. To predict the future amount of expert assessments you have to take into consideration the social background of the families in addition to age and gender (there is a clear correlation between age and the need of assistance). The database from nursing care assessments in 2001 was projected on a demographic model for the region of Westfalen-Lippe. The amount of requests correlates as expected with the patients age and increases exponentially. The incidence in the need of care shows relevant gender differences, but taken into consideration the very different age structure, the overall incidence is very similar. Against the background of the current nursing care law, the MDK-WL has to deal with an annual increase in assessments of 2 %. The requests for single persons are extremely often without foundation (55 % not substantially in need of care vs. 35 %). Looking at the requests of couples, it shows that the ones for women are more often unfounded then the ones for men (39 % vs. 32 %). It is necessary to take the development of the amount of single living persons into consideration to achieve more accurate predictions for the amount of assessments.

Research on health inequalities in Latin America and the Caribbean: bibliometric analysis (1971-2000) and descriptive content analysis (1971-1995).

We conducted a bibliometric and content analysis of research on health inequalities produced in Latin American and Caribbean countries. In our bibliometric analysis (n = 576), we used indexed material published between 1971 and 2000. The content analysis (n = 269) covered the period 1971 to 1995 and included unpublished material. We found recent rapid growth in overall output. Brazil, Chile, and Mexico contributed mostly empirical research, while Ecuador and Argentina produced more conceptual studies. We found, in the literature reviewed, a relative neglect of gender, race, and ethnicity issues. We also found remarkable diversity in research designs, however, along with strong consideration of ecological and ethnographic methods absent in other research traditions.