LF:VLZP11XX Public Health - Course Information

VLZP11XX Public Health - State exam

Faculty of Medicine
Autumn 2015

Extent and Intensity

0/0. 0 credit(s). Type of Completion: SRZK (closing examination).

Teacher(s)

prof. MUDr. Bc. Zuzana Derflerová Brázdová, DrSc. (lecturer)
doc. MUDr. Jindřich Fiala, CSc. (lecturer)
prof. MUDr. Drahoslava Hrubá, CSc. (lecturer)
Mgr. Pavlína Kaňová, Ph.D. (lecturer)
MUDr. Marie Kolářová, CSc. (lecturer)
MUDr. Kräuff Rainer Schwanhaeuser Wulff, MBA, Ph.D. et Ph.D., M.A. (lecturer)
doc. MUDr. Jan Šimůnek, CSc. (lecturer)
MUDr. Miroslava Zavřelová (lecturer)
Zdeňka Jochová (assistant)
Marie Sekaninová (assistant)

Guaranteed by

prof. MUDr. Drahoslava Hrubá, CSc.
Department of Public Health – Theoretical Departments – Faculty of Medicine
Supplier department: Department of Public Health – Theoretical Departments – Faculty of Medicine

Prerequisites (in Czech)

Course Enrolment Limitations

The course is only offered to the students of the study fields the course is directly associated with.

fields of study / plans the course is directly associated with

General Medicine (eng.) (programme LF, M-VL)
General Medicine (programme LF, M-VL)

Course objectives

To understand the principles of relationship between human and environment, life conditions and life style. Factors for prevention and promotion of health. Prevention: types, different significance for health prevention and promotion. The most important non-communicable diseases: epidemiology, ethiology, prevention.

Syllabus

PREVENTIVE MEDICINE AND HYGIENE
1. Man and Environment: Physical, biological, chemical and social factors in macro- and microenvironment. Their interactions. Ways of adaptation and compensation for keeping the homeostasis. "Health" and "disease", their determinants.
2. Prevention: primary and secondary prevention, tasks and aims. The most important world and Czech primary prevention programmes. NOISE: sources, impact on health, possibilities for control.
3. Light and illumination: physiology of seeing, optimal working conditions. The physiologic sense of colours.
4. Radiation: different types, their sources and impact on human health. Possibilities of control.
5. Complex of microclimate: external and internal conditions. Ways of thermoregulation. Work places with extreme microclimate, rules for drinking schedule. Long-term and short-term thermal load.
6. Biological rhythms: circadian and other types, their influence on the performances. Shift work as a risk for health. Active and passive rest. Hygiene of sleeping.
7. Air and health: the most common contaminants of ambient air, their sources and human exposure. Smog. Health consequences of the exposure to polluted air.
8. Basic toxicology: ways of exposure, intake, uptake; metabolism of xenobiotics, genetic polymorphism in the microsomal enzymes; excretion. Health insure caused by chemical exposure, carcinogenesis. Similarities and differences between children and adults in toxicology.
9. Housing and health: the most common risk factors at homes, health consequences of exposure (housing-related diseases, sick building syndrome, multiple chemical sensitivity). Ventilation, types and sense.
10. Water and health: the hygienic limits for drinking water, indicators of sewage contaminants. Trace elements in drinking water. Diseases related to water pollution. The principles for safety source of water.
11. Nutrition and health: diseases related to malnutrition and food contaminants. The role of nutrition in health promotion. Dietary guidelines. The ways for measurement of nutritional habits.
12. Waste and health: the types of waste products, their sources. Hygienic rules for safe destruction of waste products.
13. Natural and man-made chemicals in the environment: their types, point and areal sources. Environment in the Czech Republic. Principles of the monitoring of environmental pollutants. "Natural pesticides".
14. Smoking and health: Smoking as the most important single preventable risk factor of premature morbidity and mortality. Dependence on smoking as a psychiatric disease. Involuntary smoking and health consequences of exposure.
15. Working and health: risk occupational factors and related diseases. The rules for safety of occupational environment and health protection of workers.
16. Stress and health: physiologic response on stress situations. Stress- related diseases. Rules for the prevention of stress.
17. Non-communicable diseases: epidemiology, ethiology, prevention; Cardiovascular diseases, Cancer, Respiratory diseases, Allergy, Diabetes mellitus, Osteoporosis.
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EPIDEMIOLOGY OF INFECTIOUS DISEASES
1. Goals of the epidemiology.
2. The basic knowledge of epidemiology - understanding the epidemiological methodology (descriptive, analytic, experimental epidemiology).
3. Epidemic process; aetiology and risk factors of epidemic diseases.
4. Form of sources of infection.
5. Contagiosity in particular stage of the disease.
6. Cariership of pathogenic microorganisms. Animals as source of infection.
7. Transmission of infectious diseases, phases of transmission.
8. Susceptibility of the population to the infection.
9. Active and passive vaccination.
10. Natural, social-economic factors.
11. Global epidemiology, epidemiologic surveillance.
12. Programme of eradication and elimination of infectious diseases.
13. Principles of control of infectious diseases – elimination of the source, interruption of transmission of infectious agents, measures in a focus of infection.
14. Surveillance of nosocomial infections (NI), aetiology NI, risk factors of acquiring NI, sources and localization NI, the principles of control NI.
15. Decontamination, disinfection and sterilization.
16. Special epidemiology
17. Epidemiological characteristics of the intestinal infections and prevention of their spreading.
18. Epidemiological characteristics of the airborne infections and prevention of their spreading.
19. Epidemiological characteristics of blood infections and prevention of their spreading.
20. Animals as sources of infection.
21. Infections of the skin and superficial mucous membrane - epidemiological characteristics and preventing their transmission.
22. Infections as occupational diseases and their prevention.
23. Infections in travelling and their prevention.
24. Epidemiological inspection in hospitals; the monitoring of the microbiological quality of the hospital environment.
25. The control of the disinfection and sterilization. Interpretation of the results.
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SOCIAL / COMMUNITY MEDICINE
0. Qualitative methods for health research.
1. History of community medicine. Community medicine in Central Europe. Methodological, educational, moral, organizational and integrative role of social medicine.
2. Health and disease. Prevalence. Incidence, risk, rate, odds. Issues in calculating measures of disease frequency. Analysis of routinely collected data. Value and limitations of routinely collected data.
3. Death registration. Commonly used indices derived from mortality data. Summary statistics and standardisation. Direct standardisation. Health for All database.
4. Ratio measures. Estimating measures of effect for more than one level of exposure. Difference measures. Measures of effect versus measure of impact. Measures of population impact, population attributable risk, population attributable risk fraction.
5. Ecological study. Cross-sectional study. Cohort study. Case control study. Issues in design and execution. Design strategy: when to use which study.
6. Key steps in a randomised controlled trial. Size of the trial. Variants of the randomised controlled trial. Ethical issues. Analysis, interpretation and policy implications.
7. Types of variables. Distributions. Measures of central tendency. Measures of variability. Normal and log normal distributions.
8. Populations and samples. Confidence intervals. Sampling variability of proportions. Sampling variability of means. Hypothesis testing. Interpretation of p-values.
9. Correlation. Linear regression. Chi-squared test for a two-way table. Chi-squared test for trend. Validity of chi-squared tests. Epi-Info statistical package.
10. Bias, selection bias, measurement bias. Differential and non-differential misclassification. Confounding. Meta-analysis. Causality in medicine.
11. Validity of diagnostic tests, sensitivity, specificity. Repeatability. Predictive values of a test result.
12. Study designs for evaluation of screening. Selection bias, lead time bias, length bias, diagnosis bias. Criteria for a successful screening programme. Scope and levels of prevention.
13. Need, demand and use. Efficacy, effectiveness, efficiency. QALYs.
14. Health care systems. Funding mechanisms. Equity. Health care system in the Czech Republic. The health reform process.
15. Health policy for Europe. Health for All programme.
16. Community medicine in a historical perspective.
17. Measures of disease frequency.
18. Mortality statistics.
19. Comparing disease occurrence, population impact.
20. Observational studies.
21. Intervention studies.
22. Distributions and summary measures.
23. Estimation and testing.
24. Measures of association.
25. Interpretation of epidemiological studies.
26. Diagnostic tests.
27. Screening.
28. Health care planning and evaluation.
29. Health care systems.
30. Current issues in health policy.
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PUBLIC HEALTH AND HEALTHCARE ADMINISTRATION
1. What is meant by "health care"? Lay care: ranges and extent of activities, lay carers, attitudes of formal carers. Inputs to formal health care: staff, facilities, finance. Variations in inputs. Problems of definition. Historical framework for public health and health policy. Cultural conceptions and health beliefs, health as a value.
2. What is meant by "disease"? Difference between objective and subjective explanations of disease. What is meant by "a disease"? How do disease categories arise? Why do such categories change over time? History of medicine: bedside, hospital and laboratory medicine. Clinical approaches to the study of health and disease: case study and case series.
3. What is health policy? Theoretical approaches to policy making. Political system and public participation. Exogenous factors affecting policy. How far does research influence policy? Implementation of public health policy. United Nations health related organisations. European Health for All strategy. Reforms of health systems. Issues in the Czech Public Health Medicine.
4. The role of evaluation in therapeutic and prophylactic decision making. Critical assessment and interpretation of scientific data. Evidence based medicine. Meta-analysis. The advantages and limitations of epidemiology in assessing health needs, determining priorities, establishing and evaluating interventions. The value of epidemiological evidence in health policy decision-making. Health information provision for decision making. Information systems in public health.
5. Primary, secondary and tertiary prevention in the context of the natural history of the disease. Epidemiological uncertainties and their consequences for policy. Tension between strategies for populations and high risk groups for preventive interventions. The advantages and disadvantages of primary care as a setting for health promotion. Behavioural aspects of health promotion interventions at both the individual and community level. Is prevention better than cure?
6. Conceptual model of inputs and processes: felt need, demand, normative need, met need, unmet need, over met need, illness behaviour, professional judgement and rationing. Clinical iceberg. Measures of utilisation of health care: service-based, population-based. Need and use: effect of age and social class, use/need ratios, inverse care law. Use as a measure of met and unmet need.
7. Patterns in the organisation of health services. Health systems in industrialised countries. Why compare health systems? Frameworks for comparison. Primary health care.
8. Public sources of finance. Private sources of finance. Health insurance. Problems of data collection, problems of coordination. Expenditure per capita and as proportion of GDP: problems of definition of expenditure, problems of international comparisons, effect of adjustment on social sector spending. Technology assessment. What financial strategies and methods are available to improve the management of health services?
9. Outcome measures. Efficacy, efficiency, effectiveness. Cost-effectiveness analysis. Cost-utility analysis. Cost-benefit analysis. Humanity of care. Defining equity. Measuring equity. Setting priorities for health services: why set priorities for health services?, stages of priority setting, how to involve the public, consensus development methods.
10. Current state of health services. Problems in health services management: lack of knowledge about outcome, lack of use of knowledge about outcome, powerful professions, organisational complexity, environmental changes. Outcome research. Quality assurance: methods for changing behaviour or practice, education, feedback of information, incentives, administrative processes, regulation. Organisational and financial management, modelling.

Literature

required literature

ŽÁČEK, A. and J. HOLČÍK. Sociální lékařství II, Úvod do veřejného zdravotnictví. Brno: Masarykova univerzita, 1992. 130 pp. ISBN 80-210-0375-8.
KOTULÁN, Jaroslav and Drahoslava HRUBÁ. Preventivní lékařství SO. 1. vyd. Brno: Masarykova univerzita, 1993. info
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recommended literature

Required literature for PREVENTIVE MEDICINE AND HYGIENE
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1. Lener J et al: Medical hygiene. Prague - Czech Republic: Vydavatesltví Karolinum; 1997. pp 1-128.
2. Bártová J, Havránek J, Hrnčíř E, Lener J, Petrová K: General and environmental hygiene. Edited by J. Bártová. Prague - Czech Republic: 3rd Medical Faculty Charles University Prague; 1994. pp 5-87.
3. Varkey P: Mayo clinic preventive medicine and public health board review. Edited by Prathibha Varkey. New York - United States: Mayo Clinic Scientific Press - Oxford University Press; 2010. pp 111-232.
4. Brázdová Z, Fiala J: Dietary guidelines in the Czech Republic. Brno: Acta Facultatis Medicae Universitas Masarykianae; 1998.
5. Bonita R, Beaglehole R, Kjellström: Basic epidemiology. 2nd edition. Geneva - Switzerland: World Health Organization; 2006. pp 99-177.
6. www.who.int (information not found in the books).
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Required literature for EPIDEMIOLOGY
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1. Bakoss P, Baška T, Bazovská S, Kmety E, Maďar R et al: Compendium of epidemiology. Edited by Pavol Bakoss. Bratislava - Slovak Republic: Comenius University Bratislava; 1999. pp 3-138.
2. Stone DB, Armstrong WR, Macrina DM, Pankau JW: Introduction to epidemiology. Dubuque, IA - USA: Brown & Benchmark Publishers; 1996. pp 22-63, 115-150.
3. Farmer R, Lawrenson R, Miller D: Epidemiology and public health medicine. 5th edition. Oxford - U.K.: Blackwell Publishing; 2004. pp 7-13, 91-126.
4. Bonita R, Beaglehole R, Kjellström: Basic epidemiology. 2nd edition. Geneva - Switzerland: World Health Organization; 2006. pp 117-131.
5. www.who.int (information not found in the books).
6. www.cdc.gov (information not found in the books).
7. http://ecdc.europa.eu/en/Pages/home.aspx (information not found in the books).
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Required literature for SOCIAL / COMMUNITY MEDICINE, PUBLIC HEALTH AND HEALTHCARE ADMINISTRATION
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1. Study material for public health and healthcare administration (20 chapters / questions) CAN BE BORROWED at the Department of Public Health A21, office 321. Students MUST return it back the day of examination in the same conditions they borrowed it.
2. Bonita R, Beaglehole R, Kjellström: Basic epidemiology. 2nd edition. Geneva - Switzerland: World Health Organization; 2006. pp 1-60, 83-113, 165-176.
3. Seminar papers (Forty-two) in the subject’s vault VLZP11XX - Public Health State Examination Questions (Group D).
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Recommended literature for PREVENTIVE MEDICINE AND HYGIENE
Hrubá D: Occupational Medicine Practice. Basic Toxicology. (Fundamental abstracts from textbooks. LF MU: 1997).

Teaching methods

Reading and studying ALL REQUIRED LITERATURE.

The Public Health State Examination, it is an oral examination, in which each student randomly select a question from every set (group) of questions, as follows:
• Preventive medicine and hygiene.
• Epidemiology.
• Public health.
• Seminar papers on healthcare administration.

Assessment methods

STATE EXAMINATION INFORMATION:

1. To sit for examination, it will be required to successfully complete all the pre-requisite subjects.

2. Each student must register in the Information System (IS) in one of the offered examination terms. The examination has fixed examination terms / dates - (Only during the examination period, except the examination pre-term). No extra-terms will be given.

3. Students registered to an examination term will fail the term if:
a-) arrive late the examination day.
b-) they are not present and previously do not cancel the term in the stipulated periods (see IS).

4. In case of failure, EACH STUDENT CAN RETAKE THE FINAL EXAMINATION TWO MORE TIMES, only in given terms (according to Masaryk University study rules).

5. In case of failure during the third term (second resit), the student must repeat the course in the following school year.

6. All final examinations test questions are based on ALL REQUIRED LITERATURE, seminars and lectures.

7. The state examination is oral in front of a committee → Each student picks four questions up on each of the above mentioned topics.

8. STUDENTS MUST SUCCEED IN ALL QUESTIONS. FAILING ONE QUESTION (GROUP OF QUESTIONS) LEADS TO EXAMINATION FAILURE AND AS A CONSEQUENCE TO RETAKE THE WHOLE EXAMINATION AGAIN (4 QUESTIONS).

ACADEMIC MISCONDUCT, PLAGIARISM DETECTION AND ETHICAL ISSUES:

1. Any attempts of ACADEMIC MISCONDUCT, such as cheating or assisting someone else to cheat during the colloquium, will result in disciplinary actions, such as:
a-) You will be required to hand over your examination paper and asked to leave the examination room. This means, you failed the examination (examination term), with the respective score F / 4, on your academic records in the information system.
b-) Opening disciplinary proceedings.
c-) Failing the subject / course.
d-) Expulsion from university.

2. During the colloquium, it is forbidden to use items such as:
a-) Smart phones / Tablets.
b-) Laptops.
c-) To wear earphones or headphones (if not medical prescribed).
d-) To talk.

*In such cases, disciplinary actions will be taken (See above numeral 1).

Language of instruction

Czech

Further Comments

Study Materials
The course can also be completed outside the examination period.

The course is also listed under the following terms Autumn 2003, Spring 2004, Autumn 2004, Spring 2005, Autumn 2005, Spring 2006, Autumn 2006, Spring 2007, Autumn 2007, Spring 2008, Autumn 2008, Spring 2009, Autumn 2009, Spring 2010, Autumn 2010, Spring 2011, Autumn 2011, Spring 2012, Autumn 2012, Spring 2013, Autumn 2013, Spring 2014, Autumn 2014, Spring 2015, Spring 2016, Autumn 2016, Spring 2017, Autumn 2017, Spring 2018, autumn 2018, spring 2019, autumn 2019, spring 2020, autumn 2020, spring 2021, autumn 2021, spring 2022, autumn 2022, spring 2023, autumn 2023, spring 2024, autumn 2024, spring 2025.

Enrolment Statistics (Autumn 2015, recent)
Permalink: https://is.muni.cz/course/med/autumn2015/VLZP11XX

LF:VLZP11XX Public Health - Course Information

VLZP11XX Public Health - State exam

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