Learning objectives
In line with the guidelines of the "Institute for International Medical Education (IIME), Task force for Assessment" and, at the national level, of the Schools of Medicine Presidents’ Permanent Conference, the course aims at providing students with knowledge and understanding of the main themes in hygiene and public health. At the end of the course the students should be able to describe and assess the main determinants of health and to understand the importance of protecting and promoting health at the community level. In addition, they should be able to apply the acquired knowledge and understanding in epidemiologic methods in order to read and interpret scientific literature as well as in healthcare management in order to assess health systems’ features. The course also aims at providing students with the ability to gather and interpret relevant data to inform judgments that include reflection on relevant public health issues and with the ability to communicate ideas, problems and solutions to both specialist and non-specialist audiences. Last but not least, the course aims at providing student with solid learning and study methods that can be transferred to other fields of study as well as to professional life.
Prerequisites
Semeiotics and Pharmacology
Course unit content
The integrated course in HYGIENE, PUBLIC HEALTH AND HEALTH POLICIES is organized in the following modules:
• General and applied concepts of Hygiene, Preventive Medicine and Public health
• Epidemiological methods
• Healthcare management, National Health Service and primary care
• Business economics
• Ethics and bioethics
The course is structured into subsequent themes (some of them covered in the Semeiotics course).
The first theme (**) is on the epidemiology and the general prophylaxis of communicable diseases. In particular, students will learn about direct and indirect prophylaxis, chemoprophylaxis and vaccines.
The second theme is on health assessments. In particular, students will be taught epidemiologic methods and will learn about health indicators and surveillance systems.
The third theme is on health policy and management, health economics and primary care organization. In particular, students will learn about the National Health Service, public health and law, healthcare organization and ethics.
The fourth theme is on the determinants of health. In particular, students will learn about the epidemiology of diseases at high-socioeconomic impact, modifiable and non-modifiable risk factors, preventive medicine, predictive medicine, screenings, health promotion and public health strategies.
The fifth theme is on vaccine-preventable diseases. In particular, students will learn about vaccine-preventable childhood diseases, vaccine preventable diseases in older adults, the National Immunization Program schedule and vaccines-preventable cancers. In addition, students will be taught about immunization strategies and vaccine calendars guidelines.
The sixth theme in on surveillance and the control of health risk factors. In particular, students will learn about non-vaccine preventable diseases, food-borne outbreaks, international travels and heath, health emergencies, public health and disasters, injury prevention, behavioral disorders and addictions.
The seventh theme is on environmental health. In particular, students will learn about environmental risk factors and sustainable development. In addition, students will be taught about the integrated water cycle and health-related elements in architecture and city planning (eg concept of healthy buildings.)
(**) covered in the Semeiotics course
Full programme
1. General concepts of hygiene, health, and health education
• General health status of population, healthcare and health promotion
• Different types of prevention (primary, secondary, tertiary prevention)
• Health education: planning, management and intervention evaluation
• Health legislation. Globalisation and health
2. Health planning and organization - Health economy and management
• International health management (role of WHO)
• Organization of Italian Health System and Regional Health settings: from Law 833/1978 to devolution of NHS
• Hospital and local organization of NHS (Aziende, Dip. prevenzione, distretti)
• Principal components of health scheduling: national and regional health programmes
• Introduction to health economics and health organization: how to organize, production benefits and costs
• Health economics: efficiency and efficacy, equity, healthcare and health policy
• Organization: systemic analysis, organization variables, organization planning, clinical autonomy, tailor-made performances.
• Health coordination process: local health enterprise budget, main planning tools, budget estimation.
3. Epidemiological methods
• History and application of epidemiology. Sources of statistical-epidemiological data
• Descriptive epidemiological measures: crude rate, specific and standardized rate
• Epidemiological risk measures, cause-effect interpretation
• Ecological studies, cohort studies, case-control studies, case series studies
• Experimental studies and preventive trials. Validation of new drugs and vaccines
• Study design, data collection, ethical and privacy issues
• Classification and data analysis. Quality evaluation of data, epidemiological biases
4. Epidemiology of general prevention of infectious diseases Host-guest relationship,
infection sources and reservoirs, transmission mode
• Notification, default measures, diagnosis of infectious diseases
• Sterilization, disinfection and disinfestation
• Vaccine preventable diseases. Types of vaccines, strategies and vaccine schedules, passive immunoprophylaxis and chemoprophylaxis
5. Epidemiology and specific prevention of infectious diseases
• Epidemiology and prevention of airborne diseases
• Epidemiology and prevention of sexually transmitted disease and parenteral transmission
• Epidemiology and prevention of faecal-oral transmitted diseases
• Epidemiology and prevention of vector borne diseases and zoonoses
• Epidemiology and prevention of vertical-transmitted diseases
• Emerging and remerging infectious diseases.
• Travel medicine and Bioterrorism
• Epidemiology and prevention of nosocomial and opportunistic infections
• Immunization policies and schedules for infants, adolescents and adults
6. Non infectious diseases: epidemiology and prevention
• Major risk factors of chronic diseases and their prevention
• Screening: theoretical concepts and their application in Italian PH System
• Epidemiology and prevention of cardiovascular diseases
• Epidemiology and prevention of malignant tumours
• Epidemiology and prevention of other most important non infectious diseases
• Epidemiology and prevention of alcohol and substance abuse
• Epidemiology and prevention of road, domestic and work accidents
7. Environment and Health
• Environmental politics and energy systems
• Air, climate and atmospheric pollution: health effects
• Ionizing and non-ionizing radiation: health effects
• Indoor environment: microclimate, indoor air pollution, noise, light quality
• Solid waste management: classification, collection and disposal
• Soil and water hygiene: water demand, supply and safety
• Water: safety plan and risk management, sanitation
• Wastewater: collection, disposal and safe wastewater use
8. Food safety and Nutrition
• Food as vehicle of infections: foodborne diseases, food poisoning, foodborne outbreaks
• Conservation and manipulation methods, microbiological control methods of food
• Physical and chemical control methods: food sophistication, falsification and
adulteration; food additives
• HACCP system
• Nutrition: food need and nutrition disorders
Bioethics
• General notions of bioethics
• Elements of professional ethics
General Practice
• General practise evolution in Italy
• Doctor-patient communication
• Risk of errors in general practise
• Different forms of organization in general practise
• Local healthcare organization
• Emerging mental health
• Costs of local healthcare
Bibliography
• Signorelli C. Igiene, Epidemiologia e Sanità Pubblica (Secrets, VI EDIZIONE). SEU, Roma, 2011.
• Barbuti S, Bellelli E, Fara GM, Giammanco G. Igiene e medicina preventiva (4° ediz). Monduzzi, Bologna, 2011.
• Tarsitani G, Signorelli C, Mastroeni I. Igiene, Epidemiologia e Sanità Pubblica. 5000 Quesiti a scelta multipla (V EDIZIONE). SEU Roma, 2012
• Course materials (slides and lecture notes) from instructors.
Teaching methods
The course will be taught through frontal lectures as well as through case reports and interactive sessions that allow students to be faced with real word challenges and to understand how epidemiology and public health instruments are relevant and powerful across-the-board in health.
Assessment methods and criteria
Written exams in itinere (MCQs) and one oral exam on the material covered up in class.
Written exams’ grades are valid for the academic year 2013-14.
Written exams will assess students’ learning and understanding during the course; the oral exam will assess students’ critical analysis, communication skills and synthesis ability at the end of the course.
Other information
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2030 agenda goals for sustainable development
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