Impact on carbon emissions of online study for a cohort of overseas students: A retrospective cohort study.

Background: One of the benefits of online education is the potential reduction in carbon emissions through the decrease in travel to attend a university in person. We estimated the savings in CO 2 emissions of an international cohort of master's students who studied fully online from their home countries, rather than travelling to the UK and living there while attending university. Methods: The city and country of residence of a cohort of students who first enrolled in the fully online Peoples-uni/Manchester Metropolitan University Master of Public Health programme between the second semester of 2011 and the first semester 2013 were recorded. Total difference in emissions was calculated by adding the estimated aviation emissions between Manchester, UK and the cities where students resided, to the difference in per capita emissions between the country of origin and the UK for the time that the student would have spent in Manchester, based on the semester in which they first enrolled. Results: 128 students enrolled from 70 cities in 30 countries. 93 students were from a range of African countries and 18 from the Indian sub-continent. Flights to and from Manchester were estimated to have accounted for 114,553kg of CO 2 and living in Manchester for the duration of their course compared with staying in the home country would have been equivalent to 854,904kg of CO 2. The combined net savings was 969,457kg of CO 2. Conclusions: A small cohort of overseas students, largely from Africa and India, studied online rather than attending university in the UK. The likely saving by this small cohort of nearly a million kg of CO 2 emissions offers an indication of the potential environmental benefits of offering university education online to overseas students.

Improving global access to medical ethics education: a free self-paced online course on the Peoples-uni website.

In an attempt to increase global access to education about medical ethics, a free fully online course was developed on the Peoples-uni Open Online Courses site. Students came from 60 countries and were more likely to be medical practitioners, have come from the global North, and to have heard about the course through the web than other students enrolled in the Peoples-uni Open Online Courses site. Students scored high marks on the five quizzes. A third of the students gained a certificate of completion. Course feedback was overwhelmingly positive. Students stated that they learned the most from the lesson on professionalism, while other topics such as patient rights and autonomy, legal issues, and healthcare organisation and public health were also frequently mentioned. The course is an example of how open online courses can play a role in increasing awareness of medical ethics. Based on its analysis, the study identifies a need to attract interest in this area from low- and middle-income countries.

Does a bursary scheme for students in low- to middle-income countries influence outcomes in a master's programme in Public Health?

This article was migrated. The article was marked as recommended. Introduction The People's Open Access Education Initiative (Peoples-uni) provides online education for health professionals in Public Health at the master's level. Although fees are low due to the use of volunteers and Open Educational Resources, a bursary scheme is provided to waive all or some of the fees. This study tests the hypothesis that student outcomes of completing and passing modules are higher among those given a bursary than others. Methods Data were retrieved for all students enrolling between 2009-2017, including demographics and module outcomes, where available. Multivariable logistic regression was used to identify factors associated with a successful bursary application, as well as to elicit whether a successful bursary application was associated with ever completing, or ever passing, a module. Results Data were obtained from 1499 students. Of these, 624 (42%) had ever completed a module, and 513 (34%) had ever passed a module. 503 students (34%) had applied for a bursary, of whom 285 (57%) were successful. After adjusting for demographic variables, employment status and education level, students who were given a bursary were more likely to ever pass a module (adjusted odds ratio [aOR] 2.3, 95% CI 1.7,3.3), as were those who applied for a bursary but were unsuccessful (aOR 1.9, 95% CI 1.3,2.8), compared with students who had not applied for a bursary. Similar results were obtained for the outcome of completing a module. Conclusions Students who were successful in gaining a bursary, as well as those who were not but still able to enroll, were more likely to complete or pass a module than those who did not apply. These results point to the success of the bursary scheme and give us confidence to continue to offer bursaries, in order to sustain the mission of improving population health through capacity building in low resource settings.

The potential of an online educational platform to contribute to achieving sustainable development goals: a mixed-methods evaluation of the Peoples-uni online platform.

BACKGROUND: This paper reports on an online platform, People's Open Access Education Initiative (Peoples-uni), as a means of enhancing access to master's level public health education for health professionals. Peoples-uni seeks to improve population health in low- and middle-income countries by building public health capacity through e-learning at very low cost. We report here an evaluation of the Peoples-uni programme, conducted within the context of Sustainable Development Goal 4, which seeks to "ensure inclusive and quality education for all and promote lifelong learning" by 2030. The evaluation seeks to address the following three questions: (1) Did Peoples-uni meet its intended goals? (2) What were the different types of impacts that students experienced? (3) What suggestions for future changes in Peoples-uni did students recommend? METHODS: A mixed methods evaluation consisted of two parts, namely an online survey and a telephone interview. A total of 119 master's level graduates were invited to participate; responses were obtained from 71 of those invited, giving a response rate of 60%. Respondents were spread across 31 countries. Interviews were conducted with 18 respondents. RESULTS: There was strong evidence that Peoples-uni had achieved its stated goals. Potential impacts on students included knowledge to enhance practice and appreciation of context, enhanced research capacity through knowledge of public health, critical thinking and evidence-based programming, and empowerment of students about the potential of education as a means of improving their lives. Accreditation through future partnerships with local universities was recommended by students. CONCLUSIONS: Peoples-uni has been able to deliver a credible public health master's level educational programme, with positive impacts on the students who graduated. Challenges are to find a way to accredit the programme to ensure its sustainability and to see how to take full advantage of the current, and future, graduates to turn this from an education programme into a capacity-building programme with real impact.

HIV treatment and monitoring patterns in routine practice: a multi-country retrospective chart review of patient care.

Background: A study of patient records in four HIV clinics in three sub-Saharan African countries examined routine clinical care patterns and variations. Methods: Clinic characteristics were described, and patient data extracted from a sample of medical records. Data on treatment, CD4 count and viral load (VL) were obtained for the last visit in the records, dates mainly between 2015 and 2017, patient demographic data were obtained from the first clinic visit. Results: Four clinics, two in Nigeria, one in Zambia and one in Uganda, all public facilities, using national HIV treatment guidelines were included. Numbers of patients and health professionals varied, with some variation in stated frequency of testing for CD4 count and VL. Clinical guidelines were available in each clinic, and most drugs were available free to patients. The proportion of patients with a CD4 count in the records varied from 84 to 100 percent, the latest median count varied from 269 to 593 between clinics. 35% had a record of a VL test, varying from 1% to 63% of patients. Lamivudine (3TC) was recorded for more than 90% of patients in each clinic, and although there was variation between clinics in the choice of antiretroviral therapy (ART), the majority were on first line drugs consistent with guidelines.  Only about 2% of the patients were on second-line ARTs. In two clinics, 100% and 99% of patients were prescribed co-trimoxazole, compared with 7% and no patients in the two other clinics. Conclusions: The wide variation in available clinic health work force, levels and frequency of CD4 counts, and VL assessment and treatment indicate sub-optimal adherence to current guidelines in routine clinical care. There is room for further work to understand the reasons for this variation, and to standardise record keeping and routine care of HIV positive patients.

Open Online Courses in Public Health: experience from Peoples-uni.

Open Online Courses (OOCs) are offered by Peoples-uni at http://ooc.peoples-uni.org to complement the courses run on a separate site for academic credit at http://courses.peoples-uni.org. They provide a wide range of online learning resources beyond those usually found in credit bearing Public Health courses. They are self-paced, and students can enrol themselves at any time and utilise Open Educational Resources free of copyright restrictions.  In the two years that courses have been running, 1174 students from 100 countries have registered and among the 1597 enrolments in 14 courses, 15% gained a certificate of completion. Easily accessible and appealing to a wide geographical and professional audience, OOCs have the potential to play a part in establishing global Public Health capacity building programmes.

Can health indicators help policy-makers? Experience from European system of urban health indicators (EURO-URHIS).

Background: This paper proposes that Population Impact Measures (PIMs), the Population Impact Number of Eliminating a Risk Factor over a time period (PIN-ER-t) and the number of events prevented in your population (NEPP), can assist in policy making as they include relevant information which describes the impact or benefits to the population of risk factors and interventions. In this study, we explore the utilization of the indicators from European System of Urban Health Indicators System to produce the two PIMs. We identified from the indicators list the health determinants, health status and health interventions which can be linked, and searched Medline for evidence of association. We then investigated whether the type of frequency measure available for the indicator match with the measure used in PIMs, and explored data availability for the City of Manchester (UK) as an urban area. Of the 39 indicators relevant to socio-economic factors, health determinants and health status, it was possible to calculate the population impact of a risk factor, i.e. the PIN-ER-t, for only six associations, and the population impact of health interventions, i.e. NEPP, for only one out of the three listed indicators, as the relevant health conditions were not included. The results of this study suggest that if an indicator system is intended to play a part in the policy making process, then the method of presentation to policy-makers should be decided before setting up the system, as it is likely that some indicators which would be essential might not be available.

Mobilising the alumni of a Master of Public Health degree to build research and development capacity in low- and middle-income settings: The Peoples-uni.

BACKGROUND: Peoples-uni (People's Open Access Education Initiative) was established to help build Public Health capacity in low- and middle-income countries (LMICs) through postgraduate level online courses. Graduates are invited to join a virtual alumni group. We report the results of efforts to meet the need for health research capacity building by exploring how the course alumni could be mobilised to perform collaborative research into the health problems of their populations. METHODS: Two online surveys of Peoples-uni graduates were conducted with graduates from the first two and first four cohorts in 2013 and 2014, respectively, to explore the formation of an alumni group that would collaborate to further the research and development agenda in LMICs. This was followed by feedback on research-related activity and outcomes via the online alumni and tutors' forum to estimate early indicators of alumni success in relation to capacity building in both the conduct and utilisation of research. RESULTS: Responses were received from 26 (87% response rate) graduates of the first survey and 42 (60% response rate) of the second survey. Overall, 92% of the respondents to the first survey supported the creation of an alumni group, especially if it helped to develop their own research skills and improve the health of their populations. Findings from the second survey showed that study with Peoples-uni was felt to have had a major or potential impact on the careers of the respondents, with 19% of graduates having progressed to a PhD programme to further their research skills, and a further 48% being in the process of applying or intending to apply for doctoral studies. Further feedback shows that at least one collaborative study has been completed and published by alumni members with other collaborative studies planned. Ongoing support has been provided to graduates to help them publish their work and apply for individual or collaborative research grants. CONCLUSIONS: Harnessing the alumni of a Masters level course to perform collaborative research has considerable potential to build research capacity in LMICs.

Perceived value of applying Information Communication Technology to implement guidelines in developing countries; an online questionnaire study among public health workers.

INTRODUCTION: Practice guidelines can be used to support healthcare decision making. We sought to identify the use, and barriers to the implementation, of electronic based guidelines to support decision-making in maternal and child healthcare (MCH) and the rational use of medicines, in developing countries. METHODS: Graduates who had gained the Master of Public Health degree through the Peoples-uni (postgraduate public health education in developing countries) were sent an online survey questionnaire which had been piloted. Two reminders were sent to non-respondents at intervals of 10 days. Results were explored using descriptive analyses. RESULTS: 44 of the potential 48 graduates from 16 countries responded - most were from Africa. 82% and 89% of respondents were aware of guidelines on MCH and the rational use of medicines respectively. Electronic guidelines were more available in university hospitals than in provincial hospitals or rural care. All respondents thought that guidelines could improve the delivery of quality care, and 42 (95%) and 41 (93%) respectively thought that computers and mobile or smartphones could increase the use of guidelines in service delivery. Lack of access to computers, need to buy phone credit, need for training in the use of either computerized or phone based guidelines and fear of increased workload were potential barriers to use. CONCLUSION: There is support for the use of electronic guidelines despite limited availability and barriers to use in developing countries. These findings, and other literature, provide a guide as to how the further development of ICT based guidelines may be implemented to improve health care decision making.

Population Impact Analysis: a framework for assessing the population impact of a risk or intervention.

BACKGROUND: To describe an organizing framework, Population Impact Analysis, for applying the findings of systematic reviews of public health literature to estimating the impact on a local population, with the aim of implementing evidence-based decision-making. METHODS: A framework using population impact measures to demonstrate how resource allocation decisions may be influenced by using evidence-based medicine and local data. An example of influenza vaccination in the over 65s in Trafford to reduce hospital admissions for chronic obstructive pulmonary disease (COPD) is used. RESULTS: The number of COPD admissions due to non-vaccination of the over 65 in Trafford was 16.4 (95% confidence interval: 13.5; 19.5) and if vaccination rates were taken up to 90%, 11.5 (95% confidence interval: 9.3; 13.8) admissions could have been prevented. A total of 705 (95% confidence interval: 611; 861) people would have to be vaccinated against influenza to prevent one hospital admission. CONCLUSIONS: Population Impact Analysis can help the 'implementation' aspect of evidence for population health. It has been developed to support public health policy makers at both local and national/international levels in their role of commissioning services.

An emerging model for publishing and using open educational resources in public health.

INTRODUCTION: The open source revolution has enabled the development of open educational resources (OER) and the potential for sharing lessons learned. We present a potential model for publishing OER in public health to inform workforce development. METHODS: As part of the PHORUS (Public Health Open Resources for the University Sector) Project, a review of the literature relating to the development of OER was followed by an online search for OER resources relating specifically to public health. Furthermore, a Delphi study was conducted to identify and prioritize barriers and enablers to the production and use of public health OER. RESULTS: A wide array of OER literature was identified, although there were a limited number of public health-related papers. The key concepts influencing public health OER release found in the literature were identified as quality, ethics and values, rewards, risks and practical aspects, such as technological developments. These concepts were then further developed through the PHORUS project research findings to produce the basis of a potential model for OER development in public health. DISCUSSION/CONCLUSION: The synthesis of a literature review and Delphi study has produced a potential model to guide the development of OER in public health. The model provides a matrix where the questions about whether and how an academic can produce and publish OER are answered, according to various risks and benefits to them and their institution. We hope that this will provide practical assistance and encouragement for the academic public health community to create and share OER.

Experience with a "social model" of capacity building: the Peoples-uni.

BACKGROUND: Taking advantage of societal trends involving the "third sector", a social model of philanthropy and the open-source software and educational resource movements, provides the opportunity for online education for capacity building at low cost. The Peoples Open Access Education Initiative, Peoples-uni, aims to help build public health capacity in this way, and this paper describes its evolution. METHODS: The development of the Peoples-uni has involved the creation of an administrative infrastructure, calls for and identification of volunteers, development of both the information and communications technology infrastructure and course content, and identification of students and course delivery to them. A pilot course module was offered for delivery. RESULTS AND DISCUSSION: Volunteers have been prepared to become involved in the administrative structures, as trustees, members of advisory and quality assurance and educational oversight groups. More than 100 people have offered to be involved as course developers or as facilitators for course delivery, and to date 46 of these, from 13 countries, have been actively involved. Volunteer experts in information and communications technology have extended open-source course-delivery mechanisms. Following an encouraging pilot course module, 117 students from 23 countries have enrolled in the first set of six course modules. Although the business model is not fully developed, this approach allows current module delivery at USD 50 each, to be more affordable to the target audience than traditional university-based education. CONCLUSION: A social model of capacity building in public health has been started and has been able to attract volunteers and students from a wide range of countries. The costs are likely to be low enough to allow this method to make a substantial contribution to capacity building in low-income settings.

Potential population impact of changes in heroin treatment and smoking prevalence rates: using Population Impact Measures.

BACKGROUND: The drug misuse and asthma are major health problems in urban settings. There are effective interventions to reduce cigarette smoking and also to treat heroin use; in the context of European System of Urban Health Indicators Project (EURO-URHIS), we explored the use of Population Impact Measures (PIMs) to describe the potential for increase in methadone use and reduction in cigarette smoking to reduce deaths -from heroin use- and asthma events in examples of urban populations. METHODS: The two PIMs calculated here are the Number of Events Prevented in your Population (NEPP) and the Population Impact Number of Eliminating (or reducing the prevalence of) a Risk Factor (PIN-ER-t). RESULTS: Increasing methadone treatment uptake from its current levels to 90% would prevent 21 (95% CI: 11-34) deaths in Manchester City, 218 (95% CI: 114-339) in Greater London and overall 1 243 (95% CI: 641-1953) in England in 1 year. In males 2 (95% CI: -22 to 28), 27 (95% CI: -296 to 363) and 170 (95% CI: -1757 to 2186) and in females 36 (95% CI: 6-70), 0 and 2312 (95% CI: 934-3783) fewer asthma cases per year would have been expected in Manchester City, Greater London and overall in England respectively, if the smoking prevalence is reduced from current levels to 20% in both sexes. CONCLUSIONS: PIMs provide estimates of absolute risk and benefit to a total population, of potential use to policy-makers since current practice and intervention goals are taken into account.

Increasing dietary fish intake has contributed to decreasing mortality from CHD among the older population in Hong Kong.

OBJECTIVE: To test whether change in the frequency of fish intake at population level would affect the trends of death from CHD and how many CHD events could be prevented in Hong Kong, a population among those with the highest fish consumption and the lowest CHD mortality in the world. DESIGN: Time trends analysis with data from repeated dietary surveys and death registration. SETTING: Hong Kong SAR, People's Republic of China. SUBJECTS: A total of 3096 men and women aged 40-69 years who participated in territory-wide surveys in 1995 or 2003 were included in the analysis of changes in dietary fish intake; all adults aged 40-69 years in Hong Kong were included in the analysis of time trends of CHD mortality. RESULTS: Over the period, the frequency of fish intake increased and CHD mortality decreased significantly in the population age group of 50-69 years, while in the age group of 40-49 years little change in both fish intake and CHD mortality was observed. It was estimated that 240 CHD deaths (or 29 % of the total) were avoided among the population aged 40-69 years in 2003, as more than half of the population consumed fish every day in Hong Kong. CONCLUSIONS: The time trend of CHD mortality was inversely related to the trend of fish intake. The frequency of fish intake may have a substantial impact on the population for the prevention of CHD deaths in Hong Kong.