EuroNews MRPH #17 has been released!
Enjoy the selection of articles written by residents from all over Europe:
I suppose that this is the first article from Turkey in EURONET-MRPH Newsletter. So, I want to share our experience for communication as first. It is very exciting and important to communicate between European students for us. It is also very important to provide a good communication medium between Turkish residents. However, it is very difficult to choose best social medium, especially if there are hundreds of residents. For example, it is estimated that there are about 500 public health residents in more than 50 medical schools in Turkey. We use google mail group and whatsapp application to get in contact. Well, most of the residents have hesitations to write or to ask to the mail group, and they find whatsapp more practical then the mail group. They think that they could get answers to their questions rapidly in whatsapp. Although, whatsapp is preferable for notifications, all residents couldn’t participate to residents’ group due to participant limitation. As a representative of residents in HASUDER (Turkish Society of Public Health Specialists), i had carried out an online survey to choose the best social medium / media which had continued for ten days in November 2018. Then, we discussed the results to decide communication media in Medical Residents Session of 20th National Public Health Congress, Antalya. Figure 1. Social Media Use of Public Health Residents for Academic Purposes Total 156 residents completed the online survey (about 1/3 of all residents). Mean age of participants was 29.3±3.2 years and mean duration of residency was 23.5±15.6 months. About three quarters of the residents (73.7%) was female. Please don’t worry; it is not an error, there is apparently female predominance in Turkish public health residents. Most of the participants (84.5%) specified that they used social media every day. More than 90.0% of residents could interest in social media several times in a week. However, only 76.3% of residents specified that they could interest in social media for academic purposes several times in a week. Youtube, mail groups and whatsapp application were the most used media for academic purposes (Figure 1). Residents preferred to communicate mostly with mail groups, whatsapp, telegram and instagram for academic communication (Figure 2). Youtube, researchgate, linkedin and academia.edu were excluded for academic communication preferences. Because, they were not suitable for mutual and group communication. Few residents chose medscape and discord under the title of “others” for both in Figure 1 and 2. It could be concluded that mail groups and whatsapp are trending media. In public health conference , we discussed that whatsapp was not enough, maybe it would be better to change it to telegram according to survey results. Instagram was a surprise in this survey. Perhaps, it might have a function in the future in terms of the public health. Ferhat Yildiz Aydin Adnan Menderes University, School of Medicine Department of Public Health Merhaba (Hello)! References and Social Media resources used Introduction History of modern society is riddled with public health breakthroughs. Advances based on the notion of prevention of disease and promotion of good health allowed for better living conditions, safe transportation, diverse and nourishing diets, and numerous other standards of developed societies most of us take for granted. In retrospect, we praise much of those advances as prototypal public health measures. Did ingenious minds behind those actions perceive themselves as public health pioneers? One might even argue that they needn’t identify as such (1). John Snow, Louis Pasteur and Robert Koch transformed the world through their work and for that they only had to subscribe to the ideal of public health – not to the profession. They were inventors that spawned a health revolution. But times have changed. We are faced with globalised world, global warming and regular political tantrums with possibly perilous consequences (2). Nations of the world are putting health high on the agenda with concerted actions such as Millennium Development Goals and Sustainable Development Goals (3). Further advancement of public health demands a different toolset and approaches from those of past eras. This holds true for public health practice on international as well as on an national or even local level (4). Modern challenges of public health require a workforce with capacities to address and overcome them (5,6). Public health practitioners of today and tomorrow need to be leaders as much as scientists and inventors (7). Development of such a workforce is the common theme of following reflections provided by a group of professionals with deep insight into education and training practices in public health. The collection of reflections starts with an overview of current status and recent initiatives in public health workforce development in the European region written by Robert Otok, Katarzyna Czabanowska, and John Middleton who are all active in Association of Schools of Public Health in the European Region, a key independent European organisation dedicated to strengthening the role of public health by improving education and training of public health professionals for both practice and research. Alberto Mateo, president of the European Network of Medical Residents in Public Health, further reflects on the topic of international cooperation and on importance of internationally harmonised curricula in public health education. Afterwards authors focus on analysing and reflecting on public health workforce development in Slovenia. Tit Albreht from National Institute of Public Health addresses the challenge of diversification of public health workforce in Slovenia. In his commentary, he stresses the importance of standard education as well as continuous professional development. Recognising the importance of having a modern and comprehensive public health educational programme for medical residents, Lijana Zaletel Kragelj from Faculty of Medicine at University of Ljubljana provides us with a summary of the transformation of Slovenian public health specialty training programme from its conception and offers us with a glimpse of what we can expect in near future. Ivan Eržen from National Institute of Public Health completes the overview of graduate and postgraduate programmes which offer public health topics in their curriculums. Acknowledging the limitations of current landscape of educational opportunities in public health he points out the need for a school of public health which has yet to be established in Slovenia. In the following commentary, Marjan Premik, one of the main protagonists of establishment of school of public health in Slovenia, introduces arguments for school of public health as an integral part of health care system. Putting the emphasis on the wider public health workforce, Mitja Vrdelja from National Institute of Public Health, gives his view on working in public health in Slovenia from a communications expert perspective and complements reflections on workforce developments from previous authors with challenges that could be solved with appropriate education and training of public health workforce. Current Perspectives are rounded up with a playful note by a discussion I had with Damir Ivanković, a former public health resident from Croatia who is presently a researcher at the Academic Medical Center in Amsterdam. Since both of us are a young public health professionals from relatively small countries we take a look at benefits and drawbacks of starting a career in such an environment. Matej Vinko Keep reading the article at: References As published in Revija Javno zdravje “Proudly by ourselves” – this was a Portuguese nationalist slogan advertised before April 25th 1974 revolution. However, globalization changed the paradigm of international relationships and communication technologies connected the whole world by a simple click. We no longer live in a place where our actions have no consequences, but rather influence people and the environment around us – both as individuals and through organizations. As you know, Public Health was defined by Acheson as “the science and art of preventing disease, prolonging life and promoting health through organized community efforts” and Ottawa Charter for Health Promotion called for “community health partnerships, health alliances or socio-ecological approaches to prevention and health promotion”. Therefore, non-governmental organizations (NGO) play an interesting role in promoting community development while remaining independent from governments. Currently, some of the most important European NGOs in Public Health area are ASPHER (Association of School of Public Health in Europe), EHMA (European Health Management Association) and EUPHA (European Public Health Association)1. The aim of most of these kind of organizations is to bring together experts to develop innovative health research and implement it through effective policy making. Another perfect example of cooperation between European public health professionals is the European Network of Medical Residents in Public Health (EuroNet MRPH), which gathers 10 national based Public Health associations training programs. Following its mission, EuroNet MRPH aims to promote the sharing of educational opportunities, facilitate exchange internships and develop international scientific research. Euronet-like networks are keen on knowledge transferring, research collaboration and they create a unique environment for ideas to develop, encouraging the rapid spread of information in Europe. The lack of bureaucracy (but not organizational anarchy) among networks is one of its strengths when comparing to governments and institutions, which makes it so useful in creating knowledge, exchanging information and spreading good practice2. Individuals from different organizations and areas can collaborate free from the constraints that exist in more hierarchical models3. Also, collaborative papers tend to get cited more often, which is an important “bonus”4. Summing up, networks should focus on five specific pillars: Figure 1. The 5C Wheel, including core features of an effective network4 Right now, in my opinion, EuroNet MRPH follows the main essentials for a successful network. That is amazing in such a short period of time, while having room for development, especially regarding partnerships and cooperation. Networks are just the bottom level of a collaboration hierarchy, gathering a huge potential for development and expansion for the following years, until they achieve a full collaboration status5. Partnerships can be defined as “contextually relevant peer-to-peer collaborations which offer a platform for sharing knowledge and growing expertise globally, working towards a common goal, across disciplines and perspectives”6. This allows organizations to explore their differences and find solutions beyond their limited visions7. Similar to networks’ main pillars, partnerships also need6: As discussed in 2018’s Winter Meeting, communication and partnerships are fields where Euronet MRPH needs to invest some workforce and time, in order to develop proper foundations for the future. As referred by Rahman, EUPHA added value to members association through contact to other European Public Health Associations and more ideas for research and collaboration, among others1. Therefore, members of both organizations in a partnership also expect to develop future collaborations through existing ones. Addressing the big elephant in the room, there are hundreds of public health related institutes and NGOs in Europe. Many of them are already connected but it’s crucial to align most important NGOs agendas in Public Health, strengthening integration policies and influence8. While integrating activities in a single network is already a complicated task, integration of activities between different organizations it’s even more problematic – but when well coordinated, they have a bigger impact. Challenges in Public Health collaboration will be hard to tackle, but young professionals willingness to act and innovate play a crucial role. Today, in my opinion, Euronet MPRH is a successful network with a clear direction, encouraging innovation and quality improvement. There is a potential in advocacy for Public Health residents and promoting community driven initiatives which still remains on hold, while a broader influence in European Public Health can also be addressed through more meaningful and structured partnerships. In the Velika Planina winter meeting, Euronet MRPH members discussed the role of partnerships for the future of the network and there was a call for reviewing Euronet MRPH partnerships in an objective way, highlighting the need for meaningful and relevant benefits for enrolled public health residents, like scholarships, reduced fees and opportunities for research collaboration. But most of all, is crucial to gather feedback from residents and understand what they expect from partnerships. In the Velika Planina winter meeting, Euronet MRPH members discussed the role of partnerships for the future of the network and there was a call for reviewing Euronet MRPH partnerships in an objective way, highlighting the need for meaningful and relevant benefits for enrolled public health residents, like scholarships, reduced fees and opportunities for research collaboration. But most of all, is crucial to gather feedback from residents and understand what they expect from partnerships. There will be many challenges in the future and it’s up to us to prepare and embrace the opportunities that they will bring. Public Health Resident Nowadays many people die from weight related diseases, these can normally be prevented by improving eating habits and lifestyle choices. But, how easy is it for people to choose better? As a dietitian and public health professional I find myself promoting healthy eating very often. However, I have realised that it is not just up to the people to try to get healthier. It is the government’s job to make it easier for everyone to make these changes. A year ago, I found myself moving to Barcelona, a city full of life and full of bars and restaurants. Asking for tap water in Barcelona is impossible as waiters argue that tap water is not drinkable in Spain. In fact, Barcelona’s water is safe to drink as it follows EU regulations and the company in charge of water in Barcelona has many ISO certifications that secure the water’s innocuousness. In addition to this, a bottle of water in Barcelona is sometimes either the same price or more expensive than a beer or sugary drinks. In contrast, countries in the European Union like the UK and France make it mandatory for bars and restaurants to give free tap water to customers, making it easier for people to choose healthier. By the same token, in consultation, I always suggest patients to choose whole meal bread and pastas over white ones. Many of them stick to refined grains given that wholemeal products are normally more expensive. It is a fact that eating refined carbs lead to increased risk of obesity and type 2 diabetes, such as it is a fact that it is cheaper to make wholemeal products than to make heavily processed ones, and still people need to pay more for getting the healthier option. The idea that to eat better is necessary to spend lots of money is a problem I have encountered many times. The current trend of organic foods makes it seem like eating healthily is only for those who can actually afford it. People from a low socioeconomic status find it impossible to eat the so-called organic products. Showing people that healthier does not necessarily mean organic or more expensive should be a public health priority. Given these points, it is evident that support from the government is essential in order to make it easier for people to choose the healthier option. Masters in Public health student at the Universitat Pompeu Fabra in Barcelona
References: Access to health services in the prison system is conditioned by legal barriers, social marginalization and stigma which can increase infectious diseases among the prison population1. The prison population is different from other populations and it’s in a situation of increased vulnerability. There are several factors that contribute to this, mainly: more exposure to violence; transmission of infectious diseases; increased unprotected sexual, confinement and overpopulation; difficulties in the patients flow up1. The number of prisoners in Portugal is about 14.000 on 2017, for a theoretical capacity of approximately 13.000, generating, thus, a panorama of indisputable overcrowding of the prison system. In addition there is also a high turn-over of inmates2. The most relevant characteristics of Portuguese prisoners are summarized in Table 1 and Figure 1. In order to achieve the goals to 2020 outlined on Onusida/Unaids and reduce the morbimortality of viral hepatitis, the General Directorate for Reinsertion and Prisional Services (Direção-Geral da Reinserção e dos Serviços Prisionais) and 28 hospitals of the National Health Service (SNS) will sign a protocol for the treatment of human immunodeficiency virus (HIV) and viral hepatitis infections in the prison population, extending to the whole country the pilot project that runs between the Hospital de São João in Porto and the prison of Custóias. This pilot project started on january 2017, in order to promote appropriate diagnostic procedures and to provide medication to cure hepatitis C. This initiative enabled the elimination of Hepatitis C in prisons in Custóias and Santa Cruz do Bispo and is now being expanded geographically and to include other viral hepatitis and HIV4. Up until now, prisoners were subject to security procedures when traveling to healthcare facilities, which caused constraints to clinical observation. From now on they will be treated in the prison itself. This new model will allow physicians – infecciologists, gastroenterologists and internists – to move to prisons to care for the HIV-infected, hepatitis B and C prison population of 45 prison facilities across the continent. In addition, screening will be done at the entrance, during and at the end of the sentence. Thus, it is expected that this protocol will shape a new approach to health care for infectious diseases in prisons. Public Health Resident, Portugal Public Health Resident, Portugal References: Sexual and reproductive health and rights (SRHR) are at the intersection of health care and the legal and moral system of a country. Issues related to SRHR are not only under the control of the woman herself, eventually her partner, and healthcare professionals, but also of lawmakers and often religious leaders. Matters as abortion, contraception, fertility and reproduction, the definition of consent, the choice of a partner, are hence both extremely intimate and public, influenced by power dynamics and contextual factors. Of abortion, in 1992 H. David wrote: “Although universally practiced, no other elective surgical procedure has evoked as much divisive public debate, generated such emotional and moral passion, or received greater sustained attention from the media”1. Abortion is indeed universally practiced, but an estimated 25% of the world’s population lives in the 66 countries where abortion is either prohibited or permitted only to save a woman’s life2. Of these, eight countries are in Europe: Northern Ireland in the United Kingdom, Ireland, Monaco, Liechtenstein, San Marino, Poland, Andorra and Malta. In the first six countries, abortion is forbidden outside extremely limited circonstances, for example, depending on the country, to avert a substantial risk to a woman’s life, in case of severe foetal impairment or if the pregnancy is a result of a sexual assault. Andorra and Malta do not allow it in any situation3. A report published in December 2017 by the Council of Europe details the effects of restrictive laws on women in Europe3. In countries with restrictive laws, womens are forced to travel outside the country to receive care, or they have to access illegal abortion, for example by buying abortion pills online, with the fear to seek post-abortion care, because of the legal implications. Travelling outside the country in fact is not always an option, for administrative and financial barriers, especially for adolescents, undocumented migrants or women at risk for domestic violence. Restrictive laws can have tragic effects on the health and lives of women, as we know from the most covered country with restrictive laws in Europe, which is Ireland. In Ireland, the 8th amendment of the Constitution, which was introduced in 1983 to recognise the right to life of the unborn as an equal to that of the mother, was repealed by referendum, on the 25th of May 2018. The repeal came after appalling events like the death by sepsis of Savita Halappavanar in 20124 and the stories of some of the around 3’000 women who every year travel to the UK to access abortion services and the efforts of grassroot activism. Activism that extends across the border to Northern Ireland, in support of the women who may theoretically face a life sentence if found guilty of having an abortion5. However, the possibility to access safe, prompt abortion care can be limited even in the European countries with liberal laws, meaning where abortion is accessible on request, for reasons of distress or on broad socio-economic grounds. For example, a mandatory waiting period, with or without mandatory counseling, exists in many countries, such as Germany, Italy and The Netherlands, and was recently reintroduced in countries in Central and Eastern Europe,6 while it was suppressed by the health law of 2016 in France7. The mandatory waiting period does not fulfill any medical purpose8. Lack of professionals who provide abortion services is another barrier to access. The lack of professionals can be due to a shortage of professionals who are trained in this practice or because of the refusal to provide abortion services on grounds of conscience or religion. Some solutions to the shortage of trained professionals exist: for example, France faces a lack of gynecologists, especially in rural areas, so the health law of 2016 introduced the possibility for midwife to provide medical abortion. When refusals of care on grounds of conscience or religion are not well regulated, or the mechanisms to oversight the respect of regulations are not functional, the access to legal services is not guaranteed. For example, in Italy, in some regions more than 80% of gynecologists are objectors, and only 60% of the health care structures of the country provide abortions9, 10. These circumstances can induce European women to travel to other countries, a theme that is being studied by a research project called Europe Abortion Access Project. The first results about cross-country travel will be available in the winter of 2018, while the results on in-country travel will be available in 202011. These elements invite public health professionals to remain vigilant on abortion. The situation is ever changing and, in some cases, it is developing for the best, as we saw in Ireland, where representations on abortion have finally been shifted after years of reflections and advocacy12. In others it is stagnating or there is even a real risk of retrogression, as in Poland, where since 2016 there have been different attempts at hardening what is already one of the most restrictive abortion laws in Europe13, 14. Maria Francesca Manca References Research is one of the main projects of Euronet Medical Residents in Public Health (EuroNet MRPH) and its members represent an important part of the network workforce. These groups constitute a great opportunity to develop disruptive works at an international level and allow the residents to work with colleagues from different European countries, and learn from their experience. The benefits you can take from participating in this unique and challenging work are unlimited. Beside the working group established to provide the Association of Schools of Public Health in the European Region (ASPHER) with European residents’ feedback on the Professionalisation and Workforce Planning agenda, six research groups are currently active in the Network: All working groups are in different stages of work (Figure 1), some still gathering a team, others piloting questionnaires, and the more advanced ones are analyzing the collected data. Three of the WG are still accepting new members to collaborate (marked with a green star in the figure). During the past meeting, at Velika Planina, we organized one workshop where all WG were presented by their leads or co-leads. It was an important moment to exchange ideas and get some feedback on their ongoing work. To the new members it was explained how to join one WG or submit a new one. Together we did some brainstorming and concluded that one of the preferred topics for forming a new WG was “Influence of Politics on Health”. The challenges and strengths of a WG are several, and were also discussed: – Cultural and linguistic barriers (we’ve learnt some of the difficulties and strategies to translate a questionnaire for example); – Communication problems; – Acquire motivation, teamwork and leadership skills; – Be able to replicate a research in different countries; – Learn more about health systems and PH residency in other countries; – Ethical approvals have proved to be one of the biggest barrier to some groups; – Time management and planification skills; – Generate knowledge; – Promote PH. At the end, you can even end up presenting your work at a big conference, like Špela Vidovič did during the European Public Health (EPH) Conference in Ljubljana (Figure 2). Don’t waste this opportunity and get more involved in this project. You can get more information about each WG on the website, or by sending an email to research@euronetmrph.org. You can participate in a currently active WG or suggest a new one. Public Health resident, Portugal “My first EuroNet meeting. In Velika Planina I had the opportunity to attend my first EuroNet meeting. My colleagues who previously participated told me some stories about EuroNet-meetings so I was really looking forward to being a part of it and connecting with new people. Having the opportunity to meet colleagues from other countries and get to know them was definitely a great experience and my expectations were matched. I was able to meet great people enthusiastic of our work and exchange ideas, views and see first hand the commitment and the willingness to cooperate and how they can lead to a great teamwork. The work groups give the possibility to everyone to suggest new ideas and see who is on board with them or to give your own contribution to work groups that already exist and need some extra help. Of course the social programme is an important part of the meetings and fun is assured!” Public Health resident in Italy “As a fresh new resident in Public health, I had the great opportunity to attend the Euronet MRPH Winter Meeting in Velika planina, Slovenia. I couldn’t imagine a better way to begin the residency and to discover EuroNet. I would like to thank the warm and welcoming Slovenian team, everything was there to spend an unforgettable week-end: a wonderful landscape, a great atmosphere, tasty Slovenian food (and wine), cozy cottages, snowball fights and more important all the great people who were there and made this time amazing. It was so rewarding to discover EuroNet, all the projects and workgroups in progress between different countries. There were many interesting topics discussed, demonstrating the wide diversity of Public Health residency around Europe. It was also very stimulating and inspiring to see what can be done and to hear different professional experiences and initiatives during the pitch presentations. I came back to France with my head full of nice memories, ideas for the internship, and the aspiration to learn more about Public Health. To conclude, thank you so much EuroNet and all of its members for this beautiful meeting and nice moments, hopefully there will be plenty of others!” Public Health resident in France “Recently I attended my first EuroNet Meeting in Lubiana and it greatly exceeded expectations. Firstly, I had the opportunity to informally know about other public health residency programs, different directions and trajectories, new topics and interesting projects in the field. I especially liked the open organization of the working groups and now I’m very willing to participate. Moreover, I got to know amazing people and colleagues that shifted my research horizons and my way to intend what a public health professional may potentially be. And of course, networking was fun! Snowy chalets, cozy rooms and very nice people, what else? I would certainly recommend the experience to anyone interested in EuroNet and its activities and in networking to other public health residents across Europe. The richness of confronting with them is something I will bring home preciously.” Public Health Resident in Italy For a brief moment Ljubljana was the center of European public health. From November 29th until December 1st it hosted the biggest European public health conference. The EPH conference is – among other things – a meeting point for residents, recent residents and those who wished they could still remember how it felt like to be a resident. But they are simply too far into their careers and those feelings and memories are getting harder and harder to recall. Let us all take a minute of mindful meditation to sympathize with our experienced colleagues. Having an event of such a scale hosted by one of the EuroNet MRPH member countries made a solid case for organizing one of the regular meetings EuroNet members cherish so much in Slovenia. Many residents from EuroNet countries were attending the conference and we could feed two birds with one scone if we organised the winter meeting back-to-back with EPH. The only problem, if we can put it this way, was that most of the residents planning to come to the winter meeting were experiencing the city of Ljubljana, listening to presentations, and sitting in lecturing halls already for at least 4 days of the EPH conference. We assumed they could use a change of scenery and so we decided to organize the winter meeting in a secluded snow-capped mountain not that far away from our green capital. And so we booked buses, funiculars, chairlifts (yes, chairlifts) to take us up to the mountain called Velika planina where chalets with wood-burning fireplaces awaited us and kept us warm for the 3 days we’ve spent there. Programme of the meeting had a clear focus on EuroNet inner workings and projects of our fellow residents. General assembly was split in two parts this time. We started the meeting with a dinner and continued with the first part of the general assembly in the same restaurant which happened to be the only closed space on the mountain big enough for 45 people to occupy at the same time. The second day was the day when majority of work was done. First on schedule were pitch presentations where some of the work EuroNetters are involved in was showcased. Topics covered ranged from surveillance of communicable diseases, public health advocacy initiatives to ethics of vaccine hesitancy. Afternoon sessions kicked off with working groups focusing on internship facilitation, communication and research activities. A new format of session was introduced during the meeting as we conducted the first ever EuroNet-athon (mimicking the well-known hackathon format). Three teams were tackling three challenges of further EuroNet growth identified by a committee comprised of old and new board members. Winner of the EuroNet-athon was announced during the second part of the general assembly. Even though not everyone followed our advice on warm clothing and footwear we managed to end the winter meeting with 0 casualties. We would even go as far as to say that the winter meeting we held at Velika planina was a big success. The idyllic location and the programme of the meeting had little to do with it. It was a big success primarily because of the people who attended. And with this in mind we are looking forward to new success stories ahead. Because EuroNet MRPH is nothing more than people that represent it. And, to borrow a line from the great James Brown, those people look like success, smell like success, feel like success and they make success happen. The Euronet Organizing Committee Slovenia
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Which Social Platform is preferred between Turkish Public Health Residents’ for Communication?
Figure 2. Social Media Communication Preferences of Public Health Residents for Academic Purposes
MD, Representative of Residents, HASUDER, Turkey
Perspectives: Public Health Workforce Development in Slovenia and Wider
National Institute of Public Health of Slovenia, Ljubljana, Slovenia
http://www.nijz.si/sites/www.nijz.si/files/uploaded/vinko_jz_03-06.pdf
A roadmap for Non-Governmental Associations’ cooperation in Public Health
Public Health Unit Lisboa Central, Portugal
References
The Government’s Role in Health Promotion
Treatment of HIV and viral hepatitis in the prison population
Figure 1. Prisoners, by age. Portugal 20172
Table 1. Characteristics of the Portuguese Prison Population, Portugal, 20172,3
Sexual and reproductive health and rights in Europe: the case of abortion
Public Health Resident, France
Working Groups Update
Figure 1 – Working group stages.
Euronet Meeting First Impressions – Velika Planina 2018
Winter Meeting Report – Velika Planina 2018
