Capacity building for public health in Lithuania: the role of the faculty of public health

Începând cu anul 1990, sistemul de sănătate din Lituania a cunoscut ample reforme care vizează crearea unui sistem modern și viabil din punct de vedere financiar, care să poată oferi servicii de înaltă probitate și să îmbunătățească calitatea sănătății populației. În prezentul articol, ne propunem să punem în discuție consolidarea capacităților în domeniul sănătății publice prin prisma Facultății de Sănătate Publică (FSP) din cadrul Universității Lituaniene pentru Științe ale Sănătății, în contextul reformării sistemului de sănătate din Lituania. Formarea specialiștilor și cercetările efectuate în domeniul sănătății publice au evoluat foarte mult pe parcursul ultimelor două decenii la Universitatea Lituaniană pentru Științe ale Sănătății, răspunzând provocărilor și necesităților în procesul reformelor în domeniul sănătății. FSP, fondată în anul 1994, a devenit cel mai mare centru de formare în domeniul sănătății publice din Lituania. Din momentul fondării FSP, și-au încheiat studiile cu succes 606 de absolvenți ai programului de studii de licență în domeniul Sănătății Publice, 348 de absolvenți ai programului de master în domeniul Sănătății Publice și 665 de absolvenți ai programului de master în domeniul Managementului Sănătății Publice, majoritatea acestora încadrându-se în sistemul de sănătate. Cercetările în domeniul sănătății publice efectuate la FSP își lărgesc sfera de activitate, fapt ce permite formarea și implementarea abordărilor moderne în domeniul sănătății publice și managementului sănătății. Se așteaptă, că atât absolvenții programelor de formare în domeniul sănătății publice, cât și cei ai altor programe conexe din cadrul FPS (spre exemplu, Asistență Socială în Medicină, Psihologie Medicală și Informatică Medicală) să activeze în echipe, care să contribuie la reducerea problemelor din domeniul sănătății și să dezvolte cu succes politici în domeniul sănătății în Lituania.Since 1990, the health sector of Lithuania has been undergoing extensive reform, aiming at creation of a financially sustainable modern health care system that can provide high quality services and improve health of the population. The aim of this paper is to discuss capacity building in public health through the development of the Faculty of Public Health (FPH) at the Lithuanian University of Health Sciences in the context of health care reform in Lithuania. Public health training and research has developed successfully throughout two decades at the Lithuanian University of Health Sciences, responding to the health challenges and emerging needs in the process of health care reform. The FPH, which was established in 1994, became the biggest public health training centre in Lithuania. Since the establishment of the FPH, 606 graduates from Bachelor program in Public Health, 348 graduates from Master of Public Health and 665 graduates from Master of Management of Public Health successfully completed their studies and majority of them joined Lithuanian health care system. Public health research conducted at the FPH widens its scope and creates new evidence, which enables development and implementation of modern approaches in public health and health management. It is expected, that both the graduates from public health training programs, and other related programs, that are offered at the FPH (e.g. Social Work in Medicine, Health Psychology and Health Informatics) will work closely in the teams contributing to reduction of health challenges and successful health policy development in Lithuania

Public health workforce capacity building: the use of quality assurance indicators for the improvement in public health programmes

Agenţia Europeană pentru Acreditare în Sănătate Publică (APHEA), Bruxelles, Belgia, Școala de Sănătate Publică Charité-Universitätsmedizin, Berlin, Germania, Departamentul Sănătate Publică și Pediatrie, Școala de Medicină, Universitatea din Torino, Italia, Facultatea de Sănătate Publică, Universitatea Lituaniană de Știinţe în Sănătate, Kaunas, Lituania, Comitetul de Acreditare, Agenţia Europeană pentru Acreditare în Sănătate Publică (APHEA), Bruxelles, Belgia, Școala de Sănătate Publică Charité-Universitätsmedizin, Berlin, GermaniaRezumat În 2011, a fost fondată Agenţia Europeană pentru Acreditare în Sănătate Publică (APHEA). Această agenţie a fost o culminaţie a celor peste 25 de ani de activitate pentru îmbunătăţirea calităţii activităţii Asociaţiei Şcolilor de Sănătate Publică din Regiunea Europeană (ASPHER). Acreditarea a înlocuit un instrument anterior, numit evaluare inter pares (evalure colegială), care a fost utilizat între 2001 și 2006, pentru a ajuta la dezvoltarea școlilor și programelor din regiunea Europei Centrale și de Est. În 2012, APHEA, ASPHER și școlile partenere au utilizat noile criterii de acreditare pentru a evalua trei școli din Regiunea Europeană care au demonstrat că, doar cu mici ajustări, există potenţial de a încadra îmbunătăţirea calităţii în procesul de acreditare. Abstract In 2011, the Agency for Public Health Education Accreditation (APHEA) was launched. This agency was a culmination of over 25 years activity on quality improvement by the Association of Schools of Public Health in the European Region (ASPHER). Accreditation superseded a previous tool called a PEER review, which was used between 2001 and 2006 to help in the development of schools and programmes in the Central Eastern European Region. In 2012, APHEA, ASPHER and partner schools used the new accreditation criteria to review three schools throughout the European Region which proved that, with small adjustments, there was a potential to incorporate a quality Improvement framework around the accreditation process

Recent developments in public health education accreditation

Summary: In 2011, ASPHER established the Agency for Public Health Education Accreditation (APHEA). This represented the culmination of nearly a quarter of a century of activities dating back to 1988 in developing and assuring quality in public health education in Europe. This article provides a brief history of APHEA, outlines current activities, and explores the experiences of some of those who have participated in the process to date

Awareness and practice of patient's rights law in Lithuania

BACKGROUND: Patient's rights law is intended to secure good medical practice, but it can also serve to improve understanding between patients and medical staff if both were aware of their rights. METHODS: Awareness and practice of the new patient's rights law in Lithuanian health care institutions was explored through a survey of 255 medical staff and 451 patients in the four Kaunas city medical units in 2002. Participation rates were 74% and 66%, respectively. RESULTS: Majority of the medical staff (85%) and little over one half of the patients (56%) had heard or read about the Law on Patient's Rights (p < 0.001). Only 50% of professionals compared to 69% of patients thought information for patients about diagnosis, treatment results and alternative treatments is necessary (p < 0.001). A clear discrepancy was indicated between physicians informing the patients (80% – 98% of physicians) and patients actually knowing (37% – 54%) their treatment prognosis, disease complications or possible alternative treatment methods. CONCLUSION: These results suggest a need for awareness-raising among patients to improve the practical implementation of the Patient's Rights Law in Lithuania

Mortality inequalities by occupational class among men in Japan, South Korea and eight European countries : a national register-based study, 1990-2015

Background We compared mortality inequalities by occupational class in Japan and South Korea with those in European countries, in order to determine whether patterns are similar. Methods National register-based data from Japan, South Korea and eight European countries (Finland, Denmark, England/Wales, France, Switzerland, Italy (Turin), Estonia, Lithuania) covering the period between 1990 and 2015 were collected and harmonised. We calculated age-standardised all-cause and cause-specific mortality among men aged 35-64 by occupational class and measured the magnitude of inequality with rate differences, rate ratios and the average inter-group difference. Results Clear gradients in mortality were found in all European countries throughout the study period: manual workers had 1.6-2.5 times higher mortality than upper non-manual workers. However, in the most recent time-period, upper non-manual workers had higher mortality than manual workers in Japan and South Korea. This pattern emerged as a result of a rise in mortality among the upper non-manual group in Japan during the late 1990s, and in South Korea during the late 2000s, due to rising mortality from cancer and external causes (including suicide), in addition to strong mortality declines among lower non-manual and manual workers. Conclusion Patterns of mortality by occupational class are remarkably different between European countries and Japan and South Korea. The recently observed patterns in the latter two countries may be related to a larger impact on the higher occupational classes of the economic crisis of the late 1990s and the late 2000s, respectively, and show that a high socioeconomic position does not guarantee better health.Peer reviewe

Educational expansion and inequalities in mortality-A fixed-effects analysis using longitudinal data from 18 European populations

Objective The aim of this paper is to empirically evaluate whether widening educational inequalities in mortality are related to the substantive shifts that have occurred in the educational distribution. Materials and methods Data on education and mortality from 18 European populations across several decades were collected and harmonized as part of the Demetriq project. Using a fixed-effects approach to account for time trends and national variation in mortality, we formally test whether the magnitude of relative inequalities in mortality by education is associated with the gender and age-group specific proportion of high and low educated respectively. Results The results suggest that in populations with larger proportions of high educated and smaller proportions of low educated, the excess mortality among intermediate and low educated is larger, all other things being equal. Conclusion We conclude that the widening educational inequalities in mortality being observed in recent decades may in part be attributed to educational expansion.Peer reviewe

Determinants of educational inequalities in disability-free life expectancy between ages 35 and 80 in Europe

Socioeconomic inequalities in disability-free life expectancy (DFLE) exist across all European countries, yet the driving determinants of these differences are not completely known. We calculated the impact on educational inequalities in DFLE of equalizing the distribution of eight risk factors for mortality and disability using register-based mortality data and survey data from 15 European countries for individuals between 35 and 80 years old. From the selected risk factors, the ones that contribute the most to the educational inequalities in DFLE are low income, high body-weight, smoking (for men), and manual occupation of the father. Potentially large reductions in inequalities can be achieved in Eastern European countries, where educational inequalities in DFLE are also the largest.Peer reviewe

Determinants of inequalities in life expectancy : an international comparative study of eight risk factors

Background Socioeconomic inequalities in longevity have been found in all European countries. We aimed to assess which determinants make the largest contribution to these inequalities. Methods We did an international comparative study of inequalities in risk factors for shorter life expectancy in Europe. We collected register-based mortality data and survey-based risk factor data from 15 European countries. We calculated partial life expectancies between the ages of 35 years and 80 years by education and gender and determined the effect on mortality of changing the prevalence of eight risk factors-father with a manual occupation, low income, few social contacts, smoking, high alcohol consumption, high bodyweight, low physical exercise, and low fruit and vegetable consumption-among people with a low level of education to that among people with a high level of education (upward levelling scenario), using population attributable fractions. Findings In all countries, a substantial gap existed in partial life expectancy between people with low and high levels of education, of 2.3-8.2 years among men and 0.6-4.5 years among women. The risk factors contributing most to the gap in life expectancy were smoking (19.8% among men and 18.9% among women), low income (9.7% and 13.4%), and high bodyweight (7.7% and 11.7%), but large differences existed between countries in the contribution of risk factors. Sensitivity analyses using the prevalence of risk factors in the most favourable country (best practice scenario) showed that the potential for reducing the gap might be considerably smaller. The results were also sensitive to varying assumptions about the mortality risks associated with each risk factor. Interpretation Smoking, low income, and high bodyweight are quantitatively important entry points for policies to reduce educational inequalities in life expectancy in most European countries, but priorities differ between countries. A substantial reduction of inequalities in life expectancy requires policy actions on a broad range of health determinants. Copyright (C) 2019 The Author(s). Published by Elsevier Ltd.Peer reviewe

Determinants of inequalities in years with disability : an international-comparative study

Publisher Copyright: © The Author(s) 2020. Published by Oxford University Press on behalf of the European Public Health Association.BACKGROUND: Persons with a lower socioeconomic position spend more years with disability, despite their shorter life expectancy, but it is unknown what the important determinants are. This study aimed to quantify the contribution to educational inequalities in years with disability of eight risk factors: father's manual occupation, low income, few social contacts, smoking, high alcohol consumption, high body-weight, low physical exercise and low fruit and vegetable consumption. METHODS: We collected register-based mortality and survey-based disability and risk factor data from 15 European countries covering the period 2010-14 for most countries. We calculated years with disability between the ages of 35 and 80 by education and gender using the Sullivan method, and determined the hypothetical effect of changing the prevalence of each risk factor to the prevalence observed among high educated ('upward levelling scenario'), using Population Attributable Fractions. RESULTS: Years with disability among low educated were higher than among high educated, with a difference of 4.9 years among men and 5.5 years among women for all countries combined. Most risk factors were more prevalent among low educated. We found the largest contributions to inequalities in years with disability for low income (men: 1.0 year; women: 1.4 year), high body-weight (men: 0.6 year; women: 1.2 year) and father's manual occupation (men: 0.7 year; women: 0.9 year), but contributions differed by country. The contribution of smoking was relatively small. CONCLUSIONS: Disadvantages in material circumstances (low income), circumstances during childhood (father's manual occupation) and high body-weight contribute to inequalities in years with disability.Peer reviewe

Seasonal patterns of suicides over the period of socio-economic transition in Lithuania

BACKGROUND: In Lithuania, suicides are a grave public health problem, requiring more extensive investigation. The aim of the study was to assess the seasonal variations of suicides in Lithuania throughout the years 1993–2002, describing patterns by gender, age and method of suicide. METHODS: The study material consisted of all registered suicides (n = 16,147) committed throughout 1993–2002 in Lithuania. Smoothed trends were inspected. The seasonal effect was explored using monthly ratio statistics and spectral analysis. RESULTS: Suicides in Lithuania have a distinct annual rhythm with peaks in summer and troughs in December. The December frequencies fell by more than 23% in men and 30% in women, while June peak reached nearly 23% in men and July peak exceeded 29% in women, compare with the average levels, (p < 0.05). Hanging was the most common method of suicide both in men and women comprising up to 90% among all suicides in 1998–2002. Among different methods, only hanging suicides showed significant seasonal variations, especially in men. The seasonal amplitude has decreased over time. CONCLUSION: Substantial seasonal variations in suicides were associated with a high proportion of hanging. Extremely high suicide rates in Lithuania require further extensive studies and urgent preventive programs, taking into account the suggestions of this survey