WORLD HEALTH ORGANIZATION
~
VJI
ORGANISATION MONDIALE DE LA SANTE
.
REGIONAL OFFICE FOR THE WESTERN PACIFIC BUREAU REGIONAL DU PACIFIQUE OCCIDENTAL
ICP/CVD/003
24 October 1980 LIMITED DISTRIBUTION ENGLISH ONLY
REGIONAL COURSE ON THE EPIDEMIOLOGY AND COMMUNITY-BASED CONTROL OF CARDIOVASCULAR DISEASES Sponsored by the WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR THE WESTERN PACIFIC with the support of The Council on Epidemiology and Prevention of the International Society and Federation of Cardiology The Singapore Ministry of Health The National University of Singapore The Singapore National Health Association Singapore 1 - 12 September 1980
Regional Office for the Western Pacific Manila, Philippines
CONTENTS
1.
INTRODUCTION 1.1 1.2
•........................................•..• 1 1 1
Background........................................... Objectives •..........•...............................
2. 3.
CONDUCT OF THE COURSE EVALUATION 3.1 3.2
3 3
3.3 4.
General Participant's evaluation ...•.....................•.. Faculty's evaluation .............................. ..
4 6 8
RECOMMENDATIONS 4.1 4.2 4.3 4.4 4.5 4.6 Follow-up ..••...•.........•......................... Research support •....••........•.................... Future courses ...................................... Participants from SEARO •.••..................•..•.... Biostatistical training in the Region ............•.. Acknowledgements and Thanks ...•...•.•.•............. LIST OF PARTICIPANTS, FACULTY, OBSERVERS AND SECRETAR IAT . . . • • . . . . . . . . . . . . . . . . . . . • . . . . . . . . PROGRAMME OF ACTIVITIES LIST OF PROTOCOLS THAT FELLOWS WORKED ON LIST OF BOOKS AND REPORTS DISTRIBUTED TO PARTICIPANTS . . . . . . . . . . . . • . . . . . . . . . . . . . . . . . . . • . • .
8 8 9 10 10 10 11
ANNEX 1 ANNEX 2 ANNEX 3 ANNEX 4
17
25 27
I.
INTRODUCTION
1.1
Background
The first Regional Course on the Epidemiology and Community Control of Cardiovascular Diseases was held in Wellington, New Zealand, from 4 to 20 October 1978 and was judged by participants and faculty to have been an important and well worthwhile step forward for the Region. It was recommended that a further course be held in 1980 and that in this course a greater effort should be made to integrate the epidemiological and biostatistical teaching activities. The sub-session held in Manila on 5-7 December 1979 endorsed the Regional Office medium-term programme and encouraged continued emphasis on and development of training programmes on cardiovascular and metabolic diseases and in particular training courses, fellowships and research training grants, including senior visiting scientists. It was recommended that the next course in 1980 should be for cardiovascular diseases only and of two weeks' duration. This was accepted by the Western Pacific Advisory Committee on Medical Research (WPACMR) and recommended to the Regional Director. The Regional Adviser in Chronic Diseases, visited Singapore in February 1980 and received confirmation that the Singapore Ministry of Health, the National University of Singapore and the Singapore National Heart Foundation were willing to act as hosts for the course. 1.2 Objectives
The objectives of the course were that the participants would, on completion of the course, be able to: (1) understand the epidemiology and means of community-based control of cardiovascular diseases with special reference to the Western Pacific Region; apply statistical concepts to cardiovascular epidemiology; develop skills in order to prepare a protocol for epidemiological studies and/or control of cardiovascular problems which could be developed on return to their own countries.
(2) (3)
2.
CONDUCT OF THE COURSE
The course was officially opened on 1 September 1980 by Dr Andrew Chew, Permanent Secretary (Health), Director of Medical Services, by Professor Edward Tock, Dean, Faculty of Medicine of the National University of Singapore and by Dr L.R.L. Verstuyft on behalf of the Regional Director of the WHO Regional Office for the Western Pacific, Dr H. Nakajima. The participants together with the consultants and observers and secretariat are listed in Annex 1.
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The Sub-Committee on Cardiovascular and Metabolic Diseases had suggested to WPACMR and the Regional Director that up to five participants from the WHO South East-Asian Region might attend, and participants from Burma, India, Nepal, Sri Lanka and Thailand attended the course. The timetables of the sessions are set out in Annex 2. The programme had to be re-arranged because of the unavailability of Dr J. Tuomilehto ~n the second week, bringing community control into the first week. The teaching included formal lectures/discussions, practical exercises, literature discussions, group and individual work on development of protocols, and a selection of films. The epidemiology, community control and biostatistics lectures/ discussions were well integrated throughout the course. Appropriate practical exercises and articles were provided for participants to work at in their own time and then discussed in small or large groups. The development of protocols was the principal exercise undertaken and a number of sess~ons were allocated to this. The epidemiology, biostatistics and community control of cardiovascular disease was covered in the following modules: (1)
Introduction to epidemiology and biostatistics. Assessment of the cardiovascular diseases problem 1n the Western Pacific Region. Discovering possible modes of intervention for cardiovascular diseases.
(2)
(3)
(4) Community control of cardiovascular diseases. There were also sessions dealing with registers, receiving reports from fellows concerning cardiovascular problems in their countries, the health service implications of the epidemiology of cardiovascular diseases and lessons from migrant studies. Protocol development. It was decided that a considerable effort should be put into the preparation of protocols in areas that were relevant to participants in their own countries. A small number of fellows were already involved in ongoing epidemiological work and spent their time preparing data analysis plans. Fellows preparing proposals in similar areas such as rheumatic fever and rheumatic heart disease registers worked together but still produced their individual protocols. The aim was for participants to produce a protocol that was practical, relevant and likely to be able to be implemented on return to their own countries. They were encouraged to consider the best network of people that could be involved to develop the proposal. The part that WHO and in particular the Regional Adviser in Cardiovascular Diseases, Dr J. Tuomilehto, could play in helping 1n different ways was stressed. A list of the protocols developed by participants and certain of the observers is set out in Annex 3.
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Participants were also given the names of the 1978 course participants in their countries and the names on the consultant panel drawn up by the Sub-Committee on Cardiovascular and Metabolic Diseases. Provision of reading material. Recognizing the limited duration of the course, it had been decided to provide certain texts and other reference material for the participants and for the groups they were involved with in their home countries. The list is set out in Annex 4. Visits were made in the second week to the following Singapore Ministry of Health Departments: (a) (b) (c) Department of Cardiovascular Medicine, Tan Tock Seng Hospital Cardiac Laboratory, Singapore General Hospital Training and Health Education Department
These were of considerable interest. The Regional English Language Centre proved an excellent site for the course. The living-in allowed considerable contact between participants and faculty that enhanced the value of the course, progress of the work and good international relations. A very pleasant course dinner was hosted by the Singapore organizers, who also provided help in a large number of ways. Particular thanks are due to Professor Ng, Dr Lee Hin Peng and Miss Lim Poh Choo for the very efficient way the course ran and the fine way they responded to the many demands made on them.
3.
EVALUATION
3.1
General
The integration of the epidemiological and biostatistical teaching worked well and provided a structured programme that was well received by the participants. The majority were being exposed to new ideas and concepts relating to these disciplines, and the course content required considerable concentration and application. The background of the participants varied considerably as must be expected and this influenced their willingness and ability to take part in discussion in the large group. The small group sessions and country reviews allowed freer participation. The provision of print-outs from the Statistics Unit, WHO Geneva, on mortality trends for coronary heart disease, cerebrovascular disease and rheumatic heart disease in Australia, Fiji, Japan, New Zealand, Philippines and Singapore provided scope for a valuable practical exercise and highlighted the different age-specific trends for these conditions in the Region.
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The participants were industrious, got on well together, and the faculty found them good to work with. Some of the observers were intermittent in their attendance and the place of observers in this type of teaching course will need to be reviewed. (See Recommendations) The Regional English Language Centre provided an excellent venue for the meeting. The living accommodation was good, reasonable in cost and the meeting facilities were excellent. 3.2 Participants' evaluation
A questionnaire was administered on the first day to get information concerning participants' background and their expectations from the course. A further questionnaire was given at the end of the first week to get comments concerning progress of the course to-date and problems being experienced. A first evaluation questionnaire was given on the last day and completed by all participants, with the exception of several observers and two participants who had left the course earlier. The final evaluation questionnaire was answered anonymously and the results of selected questions are set out below. The full report is available in the Regional Office. Question: Do you remember the objectives of the course? Yes No Yes No - 19
Question:
Did you achieve these objectives?
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Question:
In future courses, do you think the proportion of teaching strategies should be: Reduced --Lectures Practicals Group discuss ions 2 ]
Same
Increased
15 7 12
2 II 3
4
Question:
Time for personal study Handouts
1
12 16
5 3
Teaching modules The sessions were ranked on a 5 to I scale. concerning these can be summarized as follows: Very useful (5) (4)
The answers to questions
Useful (3)
Not useful (2) (J)
Epidemiology Community control Biostatistics
7 8 9
6 6 6
4 3 2 1
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Question:
An effort has been made to integrate the epidemiological and biostatistical teaching Very useful Well (3) 6 (2)
Not well (1)
(5) Has this been achieved? Protocol preparation Question; 5
(4) 7
1
Do you feel there has been too much emphasis on the protocol preparation exercise at the expense of other areas? Yes 10
No 8
Uncertain 1
If so, what areas do you feel should have received more emphasis in practical work. Yes Simple statistics 8 Literature discussion 7 Epidemiological exercises such as work on screening and testing efficiency and effectiveness 11 How do you rate the other sessions? Very useful (4 ) (5 ) Evening session on country reports Films Observer variation Blood pressure film Hypertension - Signports from experience The fitness factor The story of Kauko Atherosclerosis and lipids - new perspectives Visits Tuesday 9 to Departmen t of Cardiovascular Medicine, Tan Tock Seng Hospital and to Cardiac Laboratory Singapore General Hospital Wednesday 10 to Commun i ty Education, Singapore Ministry of Health 3 5
No 3 1
Uncertain 2 4
1
Useful (3 ) 10 (2)
Not useful (1)
8
7
3 3 7 7
4 3 3 8
9 7 7 6
4
1
1
7
6
2
1
2
7
5
3
7
9
3
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Question:
Do you think future courses on epidemiology and community-based control of cardiovascular diseases should be: 10 days -
14 days 3 weeks
like this one, e.g. 1-12 Sept 1980 e.g. 30 August 12 September 1980
11
6 2
Are there biostatisticians in your country able to help with cardiovascular epidemiology? No - 6 Yes - 11 Are they available to help you? Yes - 11 No - 5 Don't know - 3
Are there biostatisticians who could take part in a special training course in statistics and data processing for cardiovascular epidemiological studies? Yes - 8 No - 4 Don't know - 7
The accommodation and meeting environment were felt to be good by almost all the participants and they were all complimentary about the organization of the meeting. The answers and informal comments by the participants have given a useful appraisal of the course and will be of value in the planning of the 1982 cou rse. The majority found the course a rewarding experience and a number commented on the new insights it had given them on the epidemiology and community-based control of cardiovascular diseases. 3.3 Faculty's evaluation (Drs Prior, Beaglehole, Brand and Tuomilehto) The participants
3.3.1
The participants came to the course from a wide range of 17 countries, training, medical background and experience. This was not a disadvantage and some of the better contributors to discussions were the older, more mature fellows. The mixture of active cardiologists, public health workers and more junior graduates still in training was not seen as a disadvantage. In fact, the exposure of a wide range of persons in this way could have considerable long-term benefits. 3.3.2 General comments - active versus passive learning
The recommendations made following the 1978 course in Wellington were taken seriously so that the principal teachers, Robert Beaglehole and Richard Brand, and the Director, Ian Prior, had been in communication for some months regarding the general planning and content of the course. This proved well worthwhile and the general standard of teaching was high. The
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provision of clearly set out summarIes of the majority of the presentations, including those in community control given by Dr J. Tuomilehto, provided participants with a valuable resource. This was supplemented by relevant artic les. 3.3.3 Practical exercises
The protocol development was deliberately made the main practical exerCise and the discussions of these in small and large groups provided scope for learning by the group as a whole. The other exercises were well worked out and the fact that all participants were encouraged to get small calculators gave them the opportunity to improve their statistical and calculating skills. 3.3.4 Films. Four different films were shown and these provided useful reViews. 3.3.5 Future activities
The Faculty were fully aware of the difficul ties some fellows might experience in undertaking epidemiological work on return to their countri.es but believed that continuing encouragement should be given to those who did have opportunities. The appointment of a Regional Adviser in Cardiovascular Diseases, Dr J. Tuomilehto, gave a clear indication of the commitment of the WHO Western Pacific Region to help develop programmes In the Region and the participants were now fully aware of this. 3.3.6 The Faculty felt that a newsletter should be developed and sent to all participants of the 1978 course, 1980 course and also the resource people on the list developed by the Sub-Committee on Cardiovascular and Metabolic Diseases in different countries. This would contain information of various types and would build up the network between people working in the Region. This could set out how different groups might seek some financial support towards projects, short-term consultant support as well as other areas of interest. 3.3.7 Future teaching courses
The general integrated teaching programme to include epidemiology, biostatistics and community control of cardiovascular disease had been well developed for this 1980 course and the same general patterns should be adopted in 1982. 3.3.8 Duration of course
The Faculty believed the course should be for 12-14 days but not longer. 3.3.9 Site of course
The Faculty believed that the course should rotate to different countries. The host country had the chance to gain considerably from the course and at the same time to make an important contribution to developments in the Region.
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3.3.10
Selection of candidates
Conversational English was an important requirement. 3.3.11 Nominations
It was hoped that calling for nominations would take place at least 12 months ahead of the 1982 course. This was not possible with the 1980 course for a variety of reasons and some candidates had relatively short notice. Early confirmation of acceptance by WHO would in future allow some reading matters to be distributed. Participants could then be asked to collect some relevant materials relating to their national statistics and cardiovascular problems.
4.
RECOMMENDATIONS
4.1
Fo llow-up
4.1.1 Questionnaire. It is recommended that the Regional Adviser in Cardiovascular Diseases be asked to send a brief questionnaire to participants in the 1978 meeting and the 1980 meeting in early 1981 so that their replies may be considered at the Third Regional Seminar on the Epidemiology and Prevention of Cardiovascular Diseases, to be held in Manila in 1981. 4.1.2 Newsletter. It is recommended that a newsletter be sent by the Regional Adviser in Cardiovascular and Metabolic Diseases to participants in the 1978 and 1980 meetings, those in the list of investigators and responsible persons for cardiovascular control drawn up by the Sub-committee on Cardiovascular and Metabolic Diseases, and other bodies such as the cardiology societies and heart foundations in the Region. 4.1.3 Research fellowships. It is clear that further strengthening in the Region of epidemiology and community-based control of cardiovascular diseases will depend on the building up in each country of persons with more detailed training and commitment in these areas. This is now starting to happen and must be encouraged further by making available training fellowships for suitable persons. Training of a minimum of 12 months in a suitable active institution is recommended. There were participants in the 1980 course who would benefit much from such training. 4.2 Research support
4.2.1 The Regional Director IS asked to continue to recognIze the important need for financial support towards research projects in the Region. Without this, many of the participants will not be able to act as an effective catalyst for the development of projects and programmes in their countries.
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4.2.2 The more developed countries must be encouraged to contribute towards activities in countries with more limited resources in a variety of ways, either through WHO, foreign aid or exchange of personnel funded in other ways. 4.2.3 Certain countries represented at the course had carried out epidemiological surveys but had had problems in the analysis and writing up of data. Identification of ways and means of providing assistance should be considered by the Sub-Committee on Cardiovascular and Metabolic Diseases. 4.2.4 1980 protocol proposals. Appropriate protocols that have been accepted by the participants' own countries should receive as much support as possible from WHO, the Regional Adviser and such other reSDurces as can be mobilized. 4.3 Future courses
4.3.1 The Faculty have been informed that the People's Republic of China has agreed to host the Third Course on the Epidemiology and Community-based Control of Cardiovascular Diseases in Beijing in 1982. This is regarded as a most welcome development. ~ 4.3.2 The 1982 course should follow the same general plan as the 1980 course. 4.3.3 It is recommended that participants be given at least six months' notice of the course so that some preparation can be undertaken priDr to the course. This will include collection of national mortality data and trends Dn certain cardiovascular diseases in their country. They will be provided with a small amount Df reading material related tD the CDurse tDpics of epidemiology, biostatistics and cDmmunity control. They will be asked to bring a hand calculator. 4.3.4 Timing of 1982 CDurse. It is recDmmended that the course CDmmence late August to early September. The course must not clash with the Regional Committee Meeting as happened in 1980 as the attendance of the Regional Adviser in Cardiovascular Diseases is considered most important. 4.3.5 It is believed that there will continue to be a need for this type of course for some years and that a two-year interval is appropriate. This must be decided on the basis of the overall evaluation of the courses. 4.3.6 Selection of participants. The nomination must be the country's prerogative. It is not recommended that a participant should attend more than one course, except in unusual circumstances. 4.3.7 Observers. The provision of positions for some observers is encouraged but they must be prepared to attend in the same way as participants and take part. This will allow certain countries to have more than the WHO quota at the meeting, provided their attendance is agreed to by the Course Director and the Regional Adviser in Cardiovascular Diseases.
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4.3.8
Special provision will always be possible for local personnel to attend any particular general session but it must be accepted that it is a programmed course requiring full participation.
4.3.9 Numbers attending.
It is considered that around 20 to 24 is the optimum number for the course as it is at present planned with a small faculty of four consultants. A greater number would require a larger faculty, and this would change the character and quality of the teaching env i ronmen t . Participants from the WHO Regional Office for South-East Asia (SEARO)
4.4 4.4.1
The attendance of five SEARO participants was well worthwhile on the occasion and they contributed well. It is felt however that in future the course should be confined to participants from the Western Pacific Region. This will help keep the course to a manageable, effective and efficient size of around 20-24 persons and also allow the major emphasis to be on the Western Pacific Region and its problems. It will also consolidate and strengthen developments more effectively. 4.4.2 SEARO course. It is recommended that, if it is felt there is a need, the Regional Director of SEARO should approach the International Council on Epidemiology and Prevention of the International Society and Federation of Cardiology and seek their help in holding a training course in epidemiology and community-based control of cardiovascular diseases in their Region. 4.5 Biostatistical training in the Region
Information from fellows confirmed that the availability of biostatisticians varied considerably in the Region. It is recommended that consideration be given to holding a course for biostatisticians in the Region with particular responsibilities for cardiovascular and community control studies.
4.6
Acknowledgements and thanks
4.6.1 It is recommended that formal thanks be extended to the different bodies concerned with the sponsoring of the course and in particular to the Singapore Coordinating Committee and Secretariat. The Faculty wish to thank the Council on Epidemiology and Prevention of the International Society and Federation of Cardiology for their contribution towards the planning of the course, including the exchange of exerC1ses.
4.6.2
"
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ANNEX 1
LIST OF PARTICIPANTS, FACULTY AND OBSERVERS AND SECRETARIAT I. AUSTRALIA PARTICIPANTS
Dr Craig Martin Research Officer Raine Foundation Centre University Department of Medicine Queen Elizabeth II Medical Centre Nedlands, Western Australia 6009 Dr Victor Pippett Medical Associate National Heart Foundation of Australia P.O. Box 2 Woden, A.C.T. 2606
PEOPLE'S REPUBLIC OF CHINA
Dr Wu Chaosu Department of Epidemiology Cardiovascular Diseases Institute and Fu Wai Hospital Chinese Academy of Medical Sciences Beijing Dr Rao Xuxu Visiting Doctor of Cardiology Cardiovascular Diseases Institute Chung Shan 2nd Road Guang Zhou, Guandong Province
FIJI
Dr Parshu Ram Consultant Physician Colonial War Memorial Hospital Suva Dr Olivia L.T. Cruz Chief of Clinics Guam Memorial Hospital P.O. Box AX Agana 96910
GUAM
'-
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Annpx I GUAM (Cont I d)
Dr Robert L. Haddock Territorial Epidemiologist Department of Public Health and Social Services Agana 96910 Dr Kong Siu-ming Consultant Physician Medical Unit "B" Queen Elizabeth Hospital Kowloon Dr M. Khalilullah Assistant Professor of Cardiology G.B. Pant Hospital New Delhi Dr Akira Endo Medical Officer Division of Health for the Aged Social Welfare Bureau Ministry of Health and Welfare 1-2-2, Kasumigaseki, Chiyoda-ku Tokyo 100 Dr Pius Premaraj Medical Officer Occupational Health Division Block-D, Ministry of Health Jalan Young Kuala Lumpur Dr L. Rampal Medical Officer of Health District Health Office Klang, Selangor, Malaysia
HONG KONG
INDIA
JAPAN
MALAYSIA
NEW ZEALAND
Dr R.J. FI ight Epidemiologist Northland Health Services P.O. Box 1491 Whangarei Dr Dhurba Lal Singh Acting Civil Surgeon Narayani Zonal Hospital Kathmandu
NEPAL
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Annex 1 PHILIPPINES Dr Oscar C. Ramos Medical Specialist I Bureau of Health Services Ministry of Health San Lazaro Compound Sta. Cruz Manila Dr Rodrigo Guanlao Junior Fellow Adult Cardiology Department Philippine Heart Center for Asia East Avenue Quezon City REPUBLIC OF KOREA Dr Shee-John Chung Chief of Cardiology Department of Internal Medicine Soon-Chun Hyang College Hospital 657-18 Han-nam-dong, Yong-sankoo Seoul Dr Soon-Jo Hong Assistant Professor Korea Cardiology Center Department of Internal Medicine St Paul Hospital Catholic Medical College Junnong-dong, Dongdaemoon-gu Seoul SAMOA Dr Sio Paulo Ainu'u Senior Medical Registrar and Acting Head, Medical Unit National Hospital Apia, Western Samoa Dr Amy Ng Suah Hoon Registrar Department of Cardiovascular Medicine Tan Tock Seng Hospital Singapore Dr Chia Boon Lock Associate Professor Department of Medicine II National University of Singapore General Hospital Outram Road Singapore 0316
SINGAPORE
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Annex 1 SINGAPORE (Cont'd)
Dr John Tay Senior Lecturer Department of Paediatrics National University of Singapore General Hospital Outram Road Singapore 0316 Dr C.D. Herat Additional Deputy Director of Medical Services Ministry of Health P.O. Box 513 Colombo Dr Uraiwan Kachacheewa Chief, Cardiology Division Department of Medicine Rajavithi Hospital Bangkok Dr Akanesi Fua Medical Officer-in-Charge Medical Ward Vaiola Hospital Nuku-alofa
SRI LANKA
THAILAND
TONGA
II.
FACULTY
Consultants
Dr Ian Prior (Course Director) Director Epidemiology Unit Wellington Hospital Riddiford Street Private Bag Wellington, New Zealand Dr Robert Beaglehole (Epidemiologist) Department of Community Medicine Auckland Medical School Auckland, New Zealand Professor Richard Brand (Biostatistic ian) Department of Biomedical and Environmental Health Sciences University of California Berkeley, California 94720 (USA)
-
15/16 -
Annex 1 WHO Coordinator Dr Jaakko Tuomilehto (Epidemiologist) Regional Adviser in Cardiovascular and Metabolic Diseases WHO Regional Office for the Western Pacific P.O. Box 2932 Manila Dr Lee Hin Peng (Epidemiologist) Department of Social Medicine and Public Health National University of Singapore Outram Road Singapore 0316 Republic of Singapore Professor C.Y. Tye (Biostatistician) Departmpnt of Social Mpdicine and Public Health National University of Singapore Outram Road Singapore 0316 Republic of Singapore
Local Coordinators
III.
OBSERVERS
Dr Sitaleki Finau (MRC Research Fellow) c/o Epidemiology Unit Wellington Hospital Private Bag Wellington, New Zealand Dr Teresa Khin May San c/o Department of Cardiovascular Medicine Tan Tock Seng Hospital Singapore, Republic of Singapore Dr Ng Yook Kim Head, Tuberculosis Control Department Tan Tock Seng Hospital Singapore, Republic of Singapore Mr Khoo Jin Hoe Research and Evaluation Department Ministry of Health Singapore, Republic of Singapore
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ANNEX 2
PROGRAMME OF ACTIVITIES First Week DATE Sunday, 31 August Monday, 31 August TIME Evening 09001000
7 September SUBJECT Introduction and Orientation Opening ceremony Welcome address by Professor Edward Tock, Dean, Faculty of Medicine University of Singapore Message from the Regional Director read by Dr L.R.L. Verstuyft, WHO Programme Coordinator Opening address by Dr Andrew Chew Permanent Secretary (Health)/ Director of Medical Services LECTURER Dr H.P. Lee
1000 10301100 1l001230 1230 14001500 1500 15151600
Reception Course objectives, outlines, assignments and expectations (A) Introduction to Epidemiology and and Biostatistics Lunch (B) Assessment of the Cardiovascular Diseases Problem in the Western Pacific Region Part I: Epidemiological overVlew Part II: Time Trends in the Cardiovascular Diseases mortality experiences of a singJe country illustrated by recent data from Japan Small group analysis of regional descriptive data Dr R. Beaglehole Prof. R. Brand Dr T. Prior Dr R. Beaglehole Prof. R. Brand
16001700
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Annex 2
First Week DATE
(Cont'd) TIME SUBJECT What do we know about the Region? - reliability of data - time trends, causes of morbidity and mortal ity LECTURER
Tuesday 2 September
0845 1000
Part III: Age adjustmpnt and agp adjusted time trends Illustrated with New Zealand data Morning tea and coffep break Small group discussions on regional patterns together with an exercise on age adjustment Lunch (C) Discovering possible modes of intervention for cardiovascular diseases Part I: An overview of strategies (Research designs) for identifying risk factors
Prof. R. Brand
1000 10301230
1230
1400 1500
Prof. R. Brand
15151630
Part II: An overview of cardiovascular diseases risk factors identifjed 1n regional and world research
Dr R. Beaglehole
Wednesday 3 September
08451000
Current issues in epidemiology of blood pressure The problems and how they might be solved Morning tea and coffee break Issues in epidemiology of coronary heart diseases
Dr R. Beaglehole Dr
T. Prior
1000 1030-
Dr R. Beaglehole
1145
I') -
Annex 2 First Week DATE (Cont'd) TIME SUBJECT Identification of problems by fellows that could be used for protocol development and application in their own countries Lunch (D) Community control of cardiovascular diseases Part I: An overview of community control strategies, including intervention studies 13301630 (1500 )
LECTURER Faculty Small groups
11451245
1245 14001515
Dr J. Tuomilehto
Part IT: Statistics appropriate to intervention studies Film: Hypertension sign posts from experience Part III: Screening for cardiovascular diseases Morning tea and coffee break Part IV: Statistical analysis of screening versus community control strategies Exercise on screening
Prof. R. Brand
Thursday, 4 September
08451000
Dr J. Tuomilehto
1000 10301130
Prof. R. Brand
11301230 1230
Lunch Monitoring of cardiovascular diseases Registers Statistical methods for analysis of registry data Country reports Dr R. Beaglehole Prof. R. Brand Participants
14001515 15301630
Evening
1945
-
20 -
Annex 2
First Week DATE Friday 5 September
(Cont'd) TIME
SUBJECT
LECTURER
08451000 1000 1030-
The North Kare1ia Study
Dr J. Tuomilehto
Morning tea and coffee break Film: The Story of Kauoko
lls
11151230 1230 1400-
Evaluation of community control programme Lunch Review of registers in the Region Perth Auckland Philippines and others Wairoa Hunter Valley The week's ectivities - a review Dinner
Dr J. Tuomilehto
ISIS
Participants and Faculty
1530
Evening Saturday 6 September
09001000 10001015
Survey design, funding and execution
Dr I. Prior
Morning tea and coffee break
10151200
Observer variation - Blood pressure film Free
Afternoon Sunday, 7 September
Leisure
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Annex 2 Second Week: DATE Monday, 8 September 8 - 12 September 1980 TIME 08451000 SUBJECT Part III: Cross sectional cohort studies: Epidemiological aspects Morning tea and coffee break Part IV: Statistical methods Methods for cross sectional and cohort studies (Part I) Small group exercise Lunch Review of stroke In the Region - Student participation Protocol - Discussion of protocols Prof. R. Brand LECTURER Dr R. Beaglehole
1000 10301130 11301230 1230 14001515 15301630 Tuesday, 9 September 08451000 1000 10301130 1130 1230 1330
Part V: Case-control studies Epidemiological aspects Morning tea and coffee break Statistical methods for cross sectional and cohort studies (Part II) Small group exerCIse Lunch Singapore Ministry of Health field visits Department of Cardiovascular Medicine, Tan Tock Seng Hospital Cardiac Laboratory, Singapore General Hospital
Dr R. Beaglehole
Prof. R. Brand
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Annex 2
Second Week DATE Wednesday, 10 September
(Cont'd) TIME SUBJECT LECTURER
08451000 1000 10301130
Statistical methods for case control studies Morning tea and coffee break Discussion of an intervention study An exercise Smoking/Blood pressure/Coronary heart diseases
Prof. R. Brand
Small groups
1130 1230 1330
Literature criticism Lunch Community education - Singapore Ministry of Health Training and Health Education Department
Evening
1945
Film showing: The Fitness Factor Atherosclerosis and lipids New perspectives
Thursday, 11 September
08451000 1000 10301130
Protocol work-up
Morning tea and coffee break Health services implications of the epidemiology of cardiovascular diseases Topics: Coronary care units and their contribution Coronary bypass surgery 1n the Western Pacific Region Priorities for health serVlce and the health dollar
1230
Lunch
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Annex 2 Second Week DATE Friday, 12 September (Cont'd) TIME 08301000 1000 10301230 1230 14001515 15301630 Saturday, 13 September SUBJECT Protocol presentation Morning tea and coffee break Protocol presentation (continued) Lunch Unresolved Issues Evaluation and final questionnaire administration Break-up Day LECTURER
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ANNEX 3
LIST OF PROTOCOLS THAT FELLOWS WORKED ON It must be understood that these were exercises and whether they are able to be developed further and implemented will depend on a number of factors. Some of these will be outside the control of the participants.
Dr Wu Chaosu and Dr Rao Xuxu - People's Republic of China "Nationwide study about the relationship between sal t intake and Hypertension" Dr L. Rampal - Malaysia "A community-based study on the epidemiology of Hypertension in Malaysia, 1981" Dr John Tay - Singapore "To evaluate the usefulness of oxygen unloading capacity (OUL) and available oxygen (AO) as prognostic criteria in children with cyanotic congenital heart disease" Dr Akira Endo - Japan "To assess the effectiveness of health education against smoking" Dr Olivia L.T. Cruz and Dr Robert Haddock - Guam "To determine prevalence of some of the ri sk factors for coronary heart disease in male and female Chamorros" Dr Pius Premaraj - Malaysia "To assess the level of cholinesteron activity among workers exposed to orgonophosphate insecticide" Dr Amy Ng - Singapore To examine the natural history of patients 45 years and below who have survived an acute myocardial infection documentin~ (a) survival pattern and (b) recurrence rates" Dr Rodrigo Guanlao - Philippines "Control of RF-RHD in Metro Manila barangay community - prImary and secondary prophylaxis"
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Annex 3 Dr Oscar Ramos - Philippines "To identify the problems In existing RF-RHD projects to recommend possible solutions" Dr Akanesi Fua - Tonga "To reVlew and revive the RF-RHD register In Tonga" Dr Craig Martin - Australia (He developed further plans for analysis of comparison of 1971 Perth Register and Hospital based data over the same period.) Dr Victor Pippett - Australia To develop a programme analysis for the national risk factory study now being undertaken in different Australian States by the National Heart Foundation.) Dr Uraiwan Kachacheewa - Thailand (A programme of analysis was developed for data from a major epidemiological study undertaken in 1976. Progress with this had been held up because of lack of epidemiological and statistical ~upport. It is hoped that this can be remedied and data published before further work is undertaken.) Dr R. Flight - New Zealand (He is involved in helping develop an integrated community-based health care programme in Northland. He is developing a RF-RHD register and this is to be coordinated with other regi~ters in New Zealand.) Dr Parshu Ram - Fiji (He is planning an evaluation of effectiveness of referrals for the treatment of cases of definite hypertension and diabetes following 1980 Hypertension and Diabetes Survey, Fiji.) Dr Teresa Khin May San - Burma Plans to encourage a RF-RHD register with a VIew to improving secondary prevention in Mandalay.
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ANNEX 4
LIST OF BOOKS AND REPORTS DISTRIBUTED TO PARTICIPANTS Epidemiology in Medical Practice DJP Barker, GRose Churchill Livingstone Medical Text 1979, second edition ISBN 0 443 01851 0 Epidemiology for the Unitiated GRose, DJP Barker Series 8 articles In B.M.J. ]978 Survey Methods in Community Medicine JH Abramson, 1979, second edition Churchill Livingstone ISBN 0 443 02021 3 Hypertension - A report of the Ontario Council on Health 1977 Arterial Hypertension - Report of the WHO Expert Committee, TRS 628 Report of the Second Regional Seminar on the Prevention and Control of Cardiovascular Diseases, Western Pacific Region, Manila, 1975 ICP CVD 001 Blood Pressure Screening in New Zealand - A report of the National Heart Foundation of New Zealand, 1977