https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth en-US Wed, 31 Dec 2008 00:00:00 +0000 OJS 3.3.0.13 http://blogs.law.harvard.edu/tech/rss 60 https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/497 The concept of ''health needs'' is one of key concepts in public health. From the public health standpoint, the most important perspective on this concept is the perspective of a population, or an individual respectively. But along this perspective there exist several other perspectives, which can be to the certain extent similar, but also could be also very different. All this enters an enormous confusion in its understanding, and consecutively this concept seems rather elusive. This confusion originates from the fact that the concept of “health needs” is very difficult to define exactly, like it is also very difficult to define exactly the concept of “health itself”, since both concepts are extremely complex entities. The module is trying to enlighten some problems concerning the “health needs” concept”. Lijana Zaletel-Kragelj, Ivan Eržen, Marjan Premik Copyright (c) 2023 Programmes for Training on Research in Public Health for South Eastern Europe https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/497 Wed, 31 Dec 2008 00:00:00 +0000 https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/504 The central problem addressed by the discipline of economics is that of resource scarcity, and so the purpose of economic evaluation is, in a very broad sense, to help decision-makers when addressing problems arising due to the scarcity issue. Therefore, such evidence is generated with the direct intention of influencing policy. Over recent years, there have been repeated expressions of concern about the usefulness of health economic analyses, and responses have tended to centre on questions of how research by health economists can be made more useful and accessible to policy makers. How an economic evaluation can be used in practice, is presented in the case of folic acid food fortification. After the introduction of folate deficiency problem and discussion of strengths and weaknesses of folic acid food fortification, it is demonstrated how an economic evaluation can add value to decision-making process. However, it is important to understand that, even if the best possible economic evaluations were available, they would be only one element in a complex process of decision-making that is also shaped by scientific evidence and political feasibility. Jerneja Farkaš-Lainščak, Lijana Zaletel-Kragelj Copyright (c) 2023 Programmes for Training on Research in Public Health for South Eastern Europe https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/504 Wed, 31 Dec 2008 00:00:00 +0000 https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/505 Demographic, social and economic status of Bulgarian third age population is one of the less favourable among the EU member states. Population in Bulgaria decreased from 8 948 649 in 1985 to 7 640 000 in 2007 with stable reduction of growing generation, standstill of at-labour-age persons and increase of the above-labour-age population. Major problem is the low employment level of ageing population, unsatisfactory health care services and unsupportive pensioning system.Elder people find themselves in completely new economic and social situation, which together with the usual changes create complexes of vulnerability, inability to manage daily tasks and health problems. The training aims at improvement of the competencies of students, professionals and aged people, their skills to manage the economic reality, enhance their health culture and diminish their exposure to diseases. Jasmine Pavlova Copyright (c) 2023 Programmes for Training on Research in Public Health for South Eastern Europe https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/505 Wed, 31 Dec 2008 00:00:00 +0000 https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/508 In recent years we have seen the successful implementation of new methods in formulating health policy, based on sound research data – the so called evidence based policy. This new approach to health policy helps experts formulate decisions on the basis of good information concerning programs and projects, through presenting supporting evidence from research, which in turn becomes the core for political development and implementation. We decided to analyze the project for a National health strategy 2007-2012 of Bulgaria and see how well it corresponds to the principles of evidence based policy. Critical evaluation of the last draft of the National health strategy 2007-2012 reveals a number of weaknesses due to the documents’ inconformity with the basic principles of evidence based policy making. We conclude with a discussion on possible implications for Bulgaria’s health policy. Petko Salchev, Nikolay Hristov, Lidia Georgieva Copyright (c) 2023 Programmes for Training on Research in Public Health for South Eastern Europe https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/508 Wed, 31 Dec 2008 00:00:00 +0000 https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/511 Raised awareness of macro-environment change pointed out the necessity for strategic planning and management of a modern health organization. The apparent management concern is how to maintain a pace with dynamic environment and innovations and to preserve proactive position. Economic transition in health systems of south east Europe countries acts as driver for strategic respond to imposed changes. Health organizations do vary by their corporate values and level of their autonomy. Like entities they have to define their purposes, missions, visions, functional capabilities and unique personalities. Also, as an open system; they must relate effectively to its external and internal environment. Milena Santrić-Miličević Copyright (c) 2023 Programmes for Training on Research in Public Health for South Eastern Europe https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/511 Wed, 31 Dec 2008 00:00:00 +0000 https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/512 This module examines the health policy development and in particular the functions of health policy analysis in the policy-making process. The module starts with a short overview of the historical background of policy analysis, which shows that the aim of policy analysis, today as in the past, has been to provide policymakers with information that can be used to solve practical problems. The module continues with a description of the policy development in the health sector. Although policy analysis is an intellectual activity, it is also embedded in a social and political process known as policymaking. Health policies are important because it is what gives content to the practices of the health sector. Policies are expressed in a whole series of practices, statements, regulations and even laws which are the result of decisions about how we will do things. Neda Milevska-Kostova, Elisaveta Stikova, Doncho Donev Copyright (c) 2023 Programmes for Training on Research in Public Health for South Eastern Europe https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/512 Wed, 31 Dec 2008 00:00:00 +0000 https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/513 Health surveys are observational epidemiological studies of health status of the population in which usually a cross-section through frequency and characteristics of health outcomes and other health related events like exposures are studied and therefore provide prevalence data. Surveys are very applicable in searching for general insight in health states and conditions that last a relatively long time as well as various risk factors for them. Their results could be efficiently used in planning public health interventions, and in fact today they represent one of the most important tools of evidence based public health. The module is presenting basic theoretical background necessary for understanding the usefulness of health surveys in planning public health interventions, as well as it provides a case study. Lijana Zaletel-Kragelj, Ivan Eržen Copyright (c) 2023 Programmes for Training on Research in Public Health for South Eastern Europe https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/513 Wed, 31 Dec 2008 00:00:00 +0000 https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/519 The article presents a legislative overview of the medicinal products from biotechnological source, which are derived from living organisms so called biosimilars. Since 2004, based on Directive 2004/27/EC the term “biogeneric” does not exist any more and the therapeutic proteins including, recombinant human insulin for the treatment of diabetes, human growth hormone for the treatment of hypo-pituitary dwarfism, interferon, erythropoietin for the treatment of anaemia in cases of chronic renal failure, various blotting factors referred to an original medicinal products are called ""biosimilars"". All these biological medicinal product often heterogeneous so that modern analytical methodology could not always characterize them in terms of differences in conformation, heterogeneity and impurity profiles. Since 20 November 2005 the Marketing authorization way for biosimilars is via the Centralized Procedure pursuant Regulation (EC) 726/2004, Annex 1. In year 2006-2007 the number of the submitted medicinal product to EMEA is 14. The survey follows and discusses the issues which are necessary for the marketing authorization of all these medicinal products to prove the safety, efficacy and quality, where appropriate pre-clinical tests or clinical trials relating to these conditions must be provided. Tatyana Benisheva-Dimitrova, Petya Trendafilova Copyright (c) 2023 Programmes for Training on Research in Public Health for South Eastern Europe https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/519 Wed, 31 Dec 2008 00:00:00 +0000 https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/520 The planning process in health care known as management cycle or cycle of organization and management is described. The cycle is divided in four main elements: planning, organization, implementation and evaluation. Each element is defined and described. Luka Kovačić, Želimir Jakšić Copyright (c) 2023 Programmes for Training on Research in Public Health for South Eastern Europe https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/520 Wed, 31 Dec 2008 00:00:00 +0000 https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/533 There is an increasing interest in eliciting feedback from patients to highlight aspects of care that need improvement and to monitor performance and quality of care. Hospitals increasingly need to adopt a patient-centred attitude. Traditionally, assessments have ignored the reports of patients in preference to technical and physiological reports of outcome. Healthcare systems have sought to achieve a balance in services that offer not only clinically effective and evidence based care, but which are also judged by patients as acceptable and beneficial. Questionnaires that ask patients to rate their care in terms of how satisfied they are tend to elicit very positive ratings, which are not sensitive to problems with the specific processes that affect the quality of care delivery. A more valid approach is to ask patients to report in detail on their Petya Trendafilova, Kiril Kirilov Copyright (c) 2023 Programmes for Training on Research in Public Health for South Eastern Europe https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/533 Wed, 31 Dec 2008 00:00:00 +0000 https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/498 Alternative medicine is becoming the important factor in health care in most countries of developed world. Generally, that development was enabled by spreading of postmodern comprehension within the Western Weltanschauung. Postmodern comprehension both, enabled deconstruction of dominant health paradigm, and stimulated acceptance of pluralistic attitudes in matters of health care. So, alternative medicine is travelling now on a rather fast track through medical institutions and even through most solemn medical campuses of developed world. Of course, there is no doubt who is holding the reins there. So, in order to cut through power plays of powers that be it is crucial to be aware of distinctions between alternative and official medicine. The differentia specifica of alternative medicine could be understood by dropping out of Cartesian paradigm and by turning to the basic postulates of holographic paradigm. Vuk Stambolović Copyright (c) 2023 Programmes for Training on Research in Public Health for South Eastern Europe https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/498 Wed, 31 Dec 2008 00:00:00 +0000 https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/499 For few decades the value of a community, empowerment, community-based care, population-based needs assessment was discussed, but not so much of the evidence of this commitment was found in the public health interventions. Potential contributions from the social sciences tend to be overwhelmed by the appeal of the biomedical and behavioural sciences. Three concepts and notions notion of community in public health were dominated: First, community- a lots and lots of people or community as the population; second could be described as community as “giant reinforcement schedule” or community as setting, with aspects of that setting being used as levers to support and maintain individual behaviour change. The third, newest, approach sees community as “eco-system with capacity to work towards solutions to its own community identified problems” or to see it as a social system. This notion of community focused on strengths instead merely on deficits. Two groups of research activities (systematic study of communities and inequality research) supported with evidence from many applied researches done through development of European Healthy Cities Project contributed to this shift in perception of the value of the community. In this course we elaborate inequity research, “System” study of communities and present case study: „Community applied research in Croatia- “triggered” by Healthy Cities“. Selma Šogorić, Aleksandar Džakula Copyright (c) 2023 Programmes for Training on Research in Public Health for South Eastern Europe https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/499 Wed, 31 Dec 2008 00:00:00 +0000 https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/501 CAM is, from the point of view of public health, a phenomenon that should be followed, analysed and controlled. Noxious as well as protective factors which accompany the implementation of CAM methods should be recognised so as to be able to inform the public of the results in a timely and accurate manner. The case study analyses the viewpoints of medical doctors, patients and the state of the phenomenon of CAM in Slovenia. A declinatory attitude of conventional medicine to CAM is present. In contrast, population express a favourable opinion on alternative methods of treatment, and more than a third of them actually make use of them. Marjan Premik, Lijana Zaletel-Kragelj Copyright (c) 2023 Programmes for Training on Research in Public Health for South Eastern Europe https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/501 Wed, 31 Dec 2008 00:00:00 +0000 https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/502 At present almost all health care systems are concerned mainly with ensuring equity, access, high quality and efficiency of health care. A very important aspect of quality, especially in public health, is its relation to scientific knowledge about effective interventions. The concept of Disease management programmes (DMPs) has been introduced to implement evidence-based clinical practice through guidelines, care protocols etc, to improve coordination among healthcare providers and assure continuity and comprehensiveness of care. DMPs organize health care in multidisciplinary, multicomponent, proactive approach focusing on the whole course of a disease, using evidence-based standards of care. There is no single definition of a Disease management programme, because of their diversity and heterogeneity. They are characterized by three main features: a knowledge base, a delivery system with coordinated care components, and a continuous improvement process. The basic advantages and uncertainties about DMPs are discussed in the module, as well as the ways and results of their implementation. A case study is presented, discussing a proposed model for Cardiovascular disease management programme in Bulgaria. Mariana Dyakova, Emilia Karaslavova, Dobriana Sidjimova Copyright (c) 2023 Programmes for Training on Research in Public Health for South Eastern Europe https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/502 Wed, 31 Dec 2008 00:00:00 +0000 https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/503 e-Health describes the application of information and communications technologies across the whole range of functions that affect the health sector. e-Health tools or solutions include products, systems and services that go beyond simply internet-based applications. They include tools for health authorities and professionals as well as personalised health systems for patients and citizens. It can improve access to healthcare and boost the quality and effectiveness of the services offered. Examples include health information networks, electronic health records, telemedicine services, personal wearable and portable communicable systems, health portals, and many other information and communication technology-based tools assisting prevention, diagnosis, treatment, health monitoring, and lifestyle management. When combined with organisational changes and the development of new skills, e-Health can help to deliver better care for less money within citizen-centred health delivery systems. Ivan Eržen Copyright (c) 2023 Programmes for Training on Research in Public Health for South Eastern Europe https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/503 Wed, 31 Dec 2008 00:00:00 +0000 https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/523 Telecare is a new means of providing healthcare and social support at home where telecommunication technologies are the medium for service provision. It uses a public telephone network and provides a means of getting help, notably for people who are at risk of falling, sudden illness, fits or seizures. Sensors added to a carephone are introduced monitor the user’s environment and health condition and alert a response centre when there is a threat to their health or well-being. Personal response systems operate in all western European countries and also, more recently, in Slovenia. Experiences gathered when establishing a pilot network of carephones and a response centre in the capital city of Ljubljana are presented along with a discussion of the efforts made to create a national network. A personal response system as a telecare application used primarily by vulnerable older people with response centres having the capacity to serve 30.000 potential users. Obstacles to their development are discussed. Drago Rudel, Malcolm Fisk Copyright (c) 2023 Programmes for Training on Research in Public Health for South Eastern Europe https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/523 Wed, 31 Dec 2008 00:00:00 +0000 https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/529 The use of qualitative and consensus building techniques enables better understanding and improved collaboration among “policy stakeholders” (politicians, administration, public health professionals and community) involved in needs assessment and health policy formulation. War, migration, and transition in South East Europe hardened most of public health activities but especially made the process of health needs assessment and formulation of health policy very difficult. Qualitative analytical methods have been introduced in Croatia over the last 10 years. Nine Croatian cities and 15 Croatian counties created City/County Health Profiles and City/County Health Plans by using qualitative methods. The greatest gain from introducing the qualitative analytical approach is wider participation in planning and managing of the resources for health at all levels, from community and regional to national level. Qualitative analytical approach was conducted through an intense and prolonged contact with a field, and real community life, enabling gaining of a 'holistic' overview of the local community. Selma Šogorić, Tea Vukušić Rukavina, Aleksandar Džakula, Ognjen Brborović Copyright (c) 2023 Programmes for Training on Research in Public Health for South Eastern Europe https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/529 Wed, 31 Dec 2008 00:00:00 +0000 https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/534 There have been various definitions of screening over the years, but simply what we are talking about in screening is seeking to identify a disease or pre-disease condition in apparently healthy individuals. This concept is now widely accepted in most of the developed word. Used wisely, it can be a powerful tool in the prevention of a disease. Screening has important ethical differences from clinical practice as the health service is targeting apparently healthy people, offering to help individuals to make better informed choices about their health. The module is presenting basic theoretical background necessary for understanding the usefulness of screenings, the screening process, and potential risks, as well as it provides a case study of breastt cancer screening. Mateja Krajc Copyright (c) 2023 Programmes for Training on Research in Public Health for South Eastern Europe https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/534 Wed, 31 Dec 2008 00:00:00 +0000 https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/540 The important role of technology is outlined and broader understanding of the term technology supported, i.e. including besides equipment also people’s know-how. The kind, types and ways of application of technologies are discussed in relation to present practice of health care. Finally, the role of AT (adequate technology), TA (technology assessment) and TT (technology transfer) are presented. Želimir Jakšić Copyright (c) 2023 Programmes for Training on Research in Public Health for South Eastern Europe https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/540 Wed, 31 Dec 2008 00:00:00 +0000 https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/500 Community nursing care forms an integral part of primary nursing care and therefore primary healthcare. It is performed in the patient's home, health centre, local community and in-the-field. The community nurse, who is a member of the nursing and health team, operates at all levels of health education: primary, secondary and tertiary, and promotes the health of the individual, family and whole population. Olga Šušteršič Copyright (c) 2023 Programmes for Training on Research in Public Health for South Eastern Europe https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/500 Wed, 31 Dec 2008 00:00:00 +0000 https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/506 Education, training and permanent learning are essential for health manpower development. Želimir Jakšić, Herman R Folmer, Luka Kovačić Copyright (c) 2023 Programmes for Training on Research in Public Health for South Eastern Europe https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/506 Wed, 31 Dec 2008 00:00:00 +0000 https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/516 Development is not only economic category, but a complex issue. Želimir Jakšić Copyright (c) 2023 Programmes for Training on Research in Public Health for South Eastern Europe https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/516 Wed, 31 Dec 2008 00:00:00 +0000 https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/531 The word quality is used every day everywhere in our lives and also in health care professionals work field. There are very general definitions which state that quality is a characteristic of things and phenomena and also more precise general and narrow professional definitions. With regard to nursing quality many authors cite Donabedian, who asserts that quality is the harmony between actual nursing and the criteria prescribed beforehand. The quality of nursing is the level of excellence. Quality assurance is merely a process that incorporates the systematic description, measurement, evaluation and, when necessary, implementation of measures to improve quality. Every organization that assumes responsibility for monitoring and promoting the quality of its work chooses a quality assurance programme. It is not possible to measure quality of care unless it has been accurately described in measurable terms. One of the ways to do this is by setting standards and clinical pathways. Marija Zaletel Copyright (c) 2023 Programmes for Training on Research in Public Health for South Eastern Europe https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/531 Wed, 31 Dec 2008 00:00:00 +0000 https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/537 The health reforms went diverse ways in different countries, but everywhere under powerful influence of political, economic and social changes. The market principles were proposed (and not very successfully applied) to a situation of poor and apparently egalitarian systems. The importance of primary care was underlined, but it was often disintegrated, overspecialized and inadequately supported. Facing a burden of social problems the centralized state solutions as well as participatory social movements had only momentary effects, so that strengthening of local and family capacities, supported by a team of generalist professionals emerged as the best choice. It was advocated by empirical results in most of developed countries. Based on experience from Croatia and other countries the strategies were identified for implementing the generalist professional approach as a basis of PHC services. Firm political decision, vocational training and development of professional identity of general practice/family medicine (physicians and nurses) were essential starting points. Organizational arrangements, academic/scientific support, and international relations have to stabilize further development. Želimir Jakšić Copyright (c) 2023 Programmes for Training on Research in Public Health for South Eastern Europe https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/537 Wed, 31 Dec 2008 00:00:00 +0000 https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/538 Nurses and midwives constitute the majority of the health care workforce in most countries of WHO's European region, and make a significant contribution to health care in a wide range of settings in hospitals and within the primary health care field. We have to motivate nurses, midwives and nursing students to accept the role in the growth of the Public Health, Health Promotion, the Principles of the Health for all and to recognize that health for all and health promotion is something essential for nurses. Recommendations from nursing meetings on these topics should help to do it. Marija Zaletel Copyright (c) 2023 Programmes for Training on Research in Public Health for South Eastern Europe https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/538 Wed, 31 Dec 2008 00:00:00 +0000 https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/539 Because there are no pure formal or informal organisations in real world, one may conclude that an organisation is a mix of formal and informal groups. Thus, its performance depends on the management ability to recognise the existence of these groups, to transform them from groups into working teams, to motivate and stimulate them to achieve organisation’s goals. We must differentiate the concept of group versus the concept of team. A simple definition of the group can be: two or more persons who come into contact for a purpose and who consider the contact meaningful. A team has to accomplish bigger goals than any individual group. The purpose of a team is to perform, achieve results and be successful in the organisation or marketplace. The literature describes several types of groups according to a set of criteria. Formal groups (work team) is created by an organisation in order to achieve a certain goal, being recognised and receiving full support from the organisation. Informal groups arise from natural attractions among individuals for social reinforcement or other benefits. They seldom share the organisational objectives and have a temporary basis.The roles within a team actually represent tasks and functions in the self-management of the team's activities. Belbin developed a test to identify individual team roles. Many teams go through a life-cycle of stages, firstly identified by Bruce Tuckman in 1965 as: forming, storming, norming and performing. This model has become the basis for further models of group development, principally adding the 5th phase of adjourning. If there are many advantages of the teamworking, there are also disadvantages that should be considered by a manager when building a team. Adriana Galan, Silvia-Gabriela Scintee Copyright (c) 2023 Programmes for Training on Research in Public Health for South Eastern Europe https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/539 Wed, 31 Dec 2008 00:00:00 +0000 https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/507 Health is perceived as most precious good, and people feel its vulnerability. Societies have been trying to absorb, ameliorate or compensate consequences and health risks with varying emphasis and varying success. Due to the uniqueness of good health to a persons’ ability to live the life he or she wants, health care and performance of health care systems are under critical observation. In this context many discussions swivel around ethics, justice, equity, equality and fairness, very often using these notions interchangeably. Sometimes they are used as arguments to challenge every economic consideration by claiming “the freedom of therapeutic choices”, and pointing out the humanitarian aspect of an individual’s health and the danger of withholding intervention options or rationing. It is not surprising to see, that many health care professionals and patients see a certain incompatibility between financing, opera-tional aspects of health care, like allocation of resources, and ethical expectations. Nevertheless, this is not necessarily so. In the following we will discuss what principles should rule a health care system. Furthermore conflicts and trade-offs between performance measures like effectiveness and efficiency and equity considerations will be discussed. Helmut Wenzel Copyright (c) 2023 Programmes for Training on Research in Public Health for South Eastern Europe https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/507 Wed, 31 Dec 2008 00:00:00 +0000 https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/509 Better health leads to faster economic growth which in turn, leads to healthier populations. Historical studies have shown that a substantial proportion of today's economic wealth can be attributed directly to past achievements in the health sphere. Health contributes to human capital through higher productivity, securing labour supply, through skills and the savings that become available for investment in physical and intellectual capital. Poor health negatively influences labour market productivity as measured by earnings and wages. At the same time, life expectancy increases with income across countries, but at a rate that becomes progressively lower as income increases due to diminishing health returns to income. However, the relationship between wealth and health is not as straightforward as was previously thought. Rather, it seems to be a more complex and multidimensional one and factors other than wealth exist that also influence the health of populations. Luka Vončina, Luka Kovačić Copyright (c) 2023 Programmes for Training on Research in Public Health for South Eastern Europe https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/509 Wed, 31 Dec 2008 00:00:00 +0000 https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/510 Introduction to system analysis and health care system. A systematic examination of a system (situation, problem) is described. Elements and boundaries of health care system. Description and taxonomy of health care system. Levels of health care with characteristics of each level. Two exercises are given. Luka Kovačić, Želimir Jakšić Copyright (c) 2023 Programmes for Training on Research in Public Health for South Eastern Europe https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/510 Wed, 31 Dec 2008 00:00:00 +0000 https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/518 The authors analyze the basic financial principles and the regulated entrepreneurship in the healthcare systems in Europe. They point out that the European countries organize, manage and finance their health care in different ways. Thus the health systems vary not only in the financial methods used, but also in the payment scheme of the insurance institution and the healthcare providers as well as the ways in which the state regulates the health services provision and the development of market relations in healthcare. Some of the most up-to-date challenges and opportunities in front of European healthcare systems are overviewed. An example case study is presented in order to illustrate the need for investing in health as well as for careful financial and regulatory planning and management. Elena Shipkovenska, Tzekomir Vodenicharov, Mariana Dyakova Copyright (c) 2023 Programmes for Training on Research in Public Health for South Eastern Europe https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/518 Wed, 31 Dec 2008 00:00:00 +0000 https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/528 In European society very important changes have occurred in recent decades. They brought different health problems. Different interventions were developed in order to preserve health in the society. Health promotion has proved to be one of the most important tools in this field. Implementation of health promotion is not possible without radical changes in approach to and method of work. As this is the case of intervention in several social subsystems, the project method is considered the most adequate tool for implementation of health promotion in organisations. Institutes of Public Health have, due to their role in the society of today, developed various kind of knowledge and skills to facilitate the implementation of project work. They are closely connected with several social subsystems so they stand a real chance of undertaking the role of project co-ordinators in health promotion. The benefits, gained by the institutes of public health through taking part in health promotion projects, will not only be those reflected in broader social community and other organisations. The new working methods will, above all, find their most rapid and positive expression in the very same institutes i.e. in the process of performing their regular professional tasks. Lijana Zaletel Kragelj, Ivan Eržen Copyright (c) 2023 Programmes for Training on Research in Public Health for South Eastern Europe https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/528 Wed, 31 Dec 2008 00:00:00 +0000 https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/530 WHO policy “Health for all” defines ten global goals and one of them is relating to health care quality: “Improvement of comprehensive high quality health care”. There are numerous definitions of health care and WHO defines it as “the level where delivered health care achieves the best results establishing the balance between the risk and benefit within specified economic conditions”. Basic dimensions of quality are equality, relevance, accessibility, acceptability, effectiveness and efficiency. Motives for establishing the system of quality in health care are professional, socio-economical, patients’ satisfaction, and the final and the most important at the same time – improvement of population health. Modern concept of quality means implementation of TQM (Total Quality Management) and CQI (Continuous Quality Improvement) that represent managing strategies whose main steps are managing consciousness, strategic planning, management implementation and training of employees. Principles are that patients’ needs, opinions and experience are the important information in permanent improvement of quality, that it has to be integrated part of everyday work, that all employees in the system of health care have professional responsibility according to permanent improvement of quality and particular responsibility have managers at all levels in health institution, that permanent improvement of quality means positive approach to work and that all activities should be based on data and information not on assumptions. Significant parameter of quality is also patients’ satisfaction, which is defined by WHO as “the level when the health system has satisfied patients’ expectations”. One of the approaches in management and explicit measuring of quality is also accreditation and its purpose is improvement of quality, gaining of information and responsibility. Vera Grujić, Mirjana Martinov Cvejin Copyright (c) 2023 Programmes for Training on Research in Public Health for South Eastern Europe https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/530 Wed, 31 Dec 2008 00:00:00 +0000 https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/536 The dramatic social and economic changes that have taken place in the past two decades in SEE, have caused the existing inequalities in health to grow even bigger, not only between but also within the countries in the region. Backed up with the national health statistics, which gives a stark illustration of the effect of economic crisis and reveals a growing health divide, the issue is recognized to deserve greater attention; the once strong and sole focus of the health services to offer better care, newer treatments and more effective drugs, in the contemporary society requires to be accompanied with the much wider scope of needs of the modern patient - including more complex social interaction, better access to information through a multitude of sources, etc. The added complexity of the interactions in the health system where both patient and the doctor play a crucial role deserves much attention if we are aimed at reducing the inequality, socio-medical and ethical disparities. Neda Milevska-Kostova, Doncho Donev Copyright (c) 2023 Programmes for Training on Research in Public Health for South Eastern Europe https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/536 Wed, 31 Dec 2008 00:00:00 +0000 https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/541 The field of public health has a distinctly uncoordinated terminology. The reason for this is that terms are taken over from different other scientific fields or are created according to historical needs and circumstances in different countries. A local jargon is frequently used. The task of this module is to review a group of terms on the enclosed list which will be often used during the public health course. It is expected from students to give short description of definition of previously unknown terms and list of terms which students find ambiguous. Želimir Jakšić, Luka Kovačić Copyright (c) 2023 Programmes for Training on Research in Public Health for South Eastern Europe https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/541 Wed, 31 Dec 2008 00:00:00 +0000 https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/514 The World Health Organization (WHO), Office for Europe initiated the Healthy Cities Project in 1986 as a long-term international development project that seeks to put health on the agenda of the local, city level political decision-makers. Healthy City is a process; it is about the change, innovation and formal system reorientation. It is not award recognizing past merits; it is a tool helping to address our cities present and future societal and developmental challenges. The Healthy City Project challenges city administrations to take seriously the process of developing health–enhancing public policies and create physical and social environments that support health but, as well, strengthen citizens’ participation. Selma Šogorić, Aleksandar Džakula Copyright (c) 2023 Programmes for Training on Research in Public Health for South Eastern Europe https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/514 Wed, 31 Dec 2008 00:00:00 +0000 https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/515 The Ottawa Charter for Health Promotion put forward the idea that health is created and lived by people within the settings of their everyday life. This settings approach to HP led to a number of initiatives, among them HPH. The HPH strategy focuses on four areas: promoting the health of patients, promoting the health of staff, changing the organization to a health promoting setting, and promoting the health of the community in the catchments area of the hospital. The need for and the relevance of setting standards for HP in hospitals was realized in the International Network of HPH, which acts as a network of networks linking all national and/or regional networks. It supports the exchange of ideas and strategies implemented in different cultures and health care systems, developing knowledge on strategic issues and enlarging the vision. Nowadays, the International Network of HPH comprises 30 member states, 33 national and/or regional networks and more than 650 hospitals. There is international consensus that patients should be given recommendations, guidance, and support with regard to HP in hospitals. An important element is the activation of the patient’s individual resources and competences in coping with disease. Example of effective intervention of this type of services is the case of Golnik hospital, where introducing specific type of treatment for specific group of patients has developed from hospital vision to national clinical pathway implementation. Mitja Košnik, Jerneja Farkaš-Lainščak Copyright (c) 2023 Programmes for Training on Research in Public Health for South Eastern Europe https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/515 Wed, 31 Dec 2008 00:00:00 +0000 https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/517 People experience a lot of health problems during their life. They deal with most of them by themselves, an only a minority of their health concerns deserves a need for professional help. Every health care system has its medical doctor of first contact, who works in the interface of the population and health care. It is characteristic that primary health care takes care of health problems that are common. Igor Švab Copyright (c) 2023 Programmes for Training on Research in Public Health for South Eastern Europe https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/517 Wed, 31 Dec 2008 00:00:00 +0000 https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/521 Mental health conceptualize a state of well-being, perceived self efficacy, competence, autonomy, intergenerational dependence and recognition of the ability to realize one's intellectual and emotional potential. Mental health care are services provided to individuals or communities by agents of the health services or professions to promote, maintain, monitor, or restore mental health. Students will become familiar with extensiveness of the problem, and levels of preventing it. It is illustrated by the case of Slovenia. Vesna Švab, Lijana Zaletel-Kragelj Copyright (c) 2023 Programmes for Training on Research in Public Health for South Eastern Europe https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/521 Wed, 31 Dec 2008 00:00:00 +0000 https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/522 Mental health is considered a public health problem due to the following particularities of the mental diseases: high incidence and prevalence; long term duration, with consequences over family, social and professional life; cause severe disability; high cost imposed on individual, family and community; associated stigma and discrimination. The main determinants of mental health are: socio-economic, demographic and psychological factors. Public health can bring a major contribution to the improvement of mental health by its main functions, such as: needs evaluation, priority setting, policy development, health promotion and disease prevention, mental health services research and development. According to WHO recommendations, mental health services should be organized based on principles of accessibility, coordinated care, continuity of care, effectiveness, equity and respect for human rights. As well, mental health care should be provided through general health services and community settings. Large and centralized psychiatric institutions need to be replaced by other more appropriate mental health services. The shifting of patients from mental hospitals to care in the community should be based, primarily on the existence of a mental health policy that promotes the development of community-based care. Policies should be drawn up with the involvement of all stakeholders and should be based upon up-to-date and reliable information. Mental health policy and service provision should take into account the context of general health systems organization and financing. For a successful implementation of the mental health policy, political, legislative, financial and administrative support is required. Adriana Galan, Silvia-Gabriela Scintee Copyright (c) 2023 Programmes for Training on Research in Public Health for South Eastern Europe https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/522 Wed, 31 Dec 2008 00:00:00 +0000 https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/524 Health at work and healthy work environments are among the most valuable assets of individuals, communities and countries. Nowadays, new broader approach is promoted, recognizing the fact that occupational health is a key, but not a unique element of workers’ health. Workers health is a public health approach to resolving the health problems of working populations including all determinants of health recognized as targets of risk management. It focuses on primary prevention of occupational and work-related diseases and injuries, protection and promotion of the health of workers. The major component of occupational safety and health system or infrastructure is occupational health service. The Basic Occupational Health Services (BOHS) are an essential service for protection of people's health at work, for promotion of health, well-being and work ability, as well as for prevention of ill-health and accident. BOHS should provide the services available to all workers, addressing to local needs and adapted to local conditions and existing resources. The development of occupational health system and policy requires strengthen governmental stewardship and ensure continuous political commitment to occupational health. OH policy should provide the development of legislation and standards in the field as well as effective mechanisms for financing of occupational health services. The expected results should be ensuring access to basic occupational health services for all workers with establishing essential requirements for service provision and providing the quality assurance systems for occupational health services. Jovanka Karadžinska-Bislimovska, Jordan Minov, Snežana Ristecka-Kuc, Sašo Stoleski, Dragan Mijakovski Copyright (c) 2023 Programmes for Training on Research in Public Health for South Eastern Europe https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/524 Wed, 31 Dec 2008 00:00:00 +0000 https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/525 Population ageing and the implications these present for care towards the end of life are major public health issues for 21st century. In the line with aging of the population, the pattern of diseases that people suffer and die from is also changing. Palliative care should be an integral part of health care and take place in any setting. Palliative care services are structured in three levels of ascending specialization, referred to the expertise of the staff providing the service: palliative care approach, general palliative care and specialist palliative care. Priority care needs for the three illness trajectories, for short period of evident decline (mostly cancer), for chronic illnesses with intermittent exacerbations and sudden dying (organ system failure), and for slow dwindling (mostly frailty and dementia) are different and specific palliative care services are needed through different length of time. Urška Lunder Copyright (c) 2023 Programmes for Training on Research in Public Health for South Eastern Europe https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/525 Wed, 31 Dec 2008 00:00:00 +0000 https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/526 Primary health care is essential health care made universally accessible to individuals and families in the community. It is a base and the entrance of the whole health care system, often has the role of gate keeper. It has to be organized according to social realities in which communities live and work. The health system is developed relatively well among the countries in the South Eastern European region. The heath personnel are well-trained and public health services are well established and organized. Around 30% of general practitioners are specialists in family medicine. Health care services in Croatia are organized on three levels: primary, secondary and tertiary. On primary level operate general/family medicine, paediatric, gynaecological and dental practices, public health nursing, diagnostic laboratories and supporting services and pharmacies. The core of primary health services in Croatia are general/family medicine, paediatric services and community nurses. According to the Health Insurance Act in Croatia, there are three main health insurance schemes: basic, supplementary and private health insurance. Želimir Jakšić, Luka Kovačić Copyright (c) 2023 Programmes for Training on Research in Public Health for South Eastern Europe https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/526 Wed, 31 Dec 2008 00:00:00 +0000 https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/527 This module describes the history and present status of psychotherapy in Austria and Slovenia. Austrian psychotherapy is one of the most developed in the world and a good example of positive development. Slovenian psychotherapy is confronted with many problems of a country in transition. Miran Možina Copyright (c) 2023 Programmes for Training on Research in Public Health for South Eastern Europe https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/527 Wed, 31 Dec 2008 00:00:00 +0000 https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/532 During a long history, hospitals were continuously changing so that diversity is one of their characteristics. Being a part of a local culture, they also reflect general global trends. At present, the winds of globalisation are stronger, following an overall trend in technology and economics. Changes in technologies will induce changes in management (“new plants do not survive in old pots”). New imaging technologies need a better clinical feed-back, and the pattern of “industry-like” hospital, where specialists work in their narrow fields on a production-line becomes inappropriate for them. Human resource management becomes more important than economic and technical management dominating at present Želimir Jakšić Copyright (c) 2023 Programmes for Training on Research in Public Health for South Eastern Europe https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/532 Wed, 31 Dec 2008 00:00:00 +0000 https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/535 The major division of health care appeared in many societies between private curative and public preventive health care. This influenced all types of health services, hospitals and primary health care units, as well as education of professionals and research. The opponents of integration have been pointing out negative experiences with integration because preventive services often have been ""eaten up"" by curative services. A special service is used in vertical programs as a vehicle to provide necessary procedures and activities to cover groups ""at risk"". There are several characteristics of vertical programs which determine their role in primary health care, which are analyzed in this module. Želimir Jakšić Copyright (c) 2023 Programmes for Training on Research in Public Health for South Eastern Europe https://biecoll2.ub.uni-bielefeld.de/index.php/publichealth/article/view/535 Wed, 31 Dec 2008 00:00:00 +0000