4 November 1982
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omi:IRD WHO REGIONAL TRAINING COURSE ON EPIDEMIOLOGY COMMUNITY-BASED CONTROL OF CARDIOVASCULAR DISEASES Beijing, People's Republic of China 30 August - 18 September 1982
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Sponsored by the
WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR THE WESTERN PACIFIC with the collaboration of the
MINISTRY OF PUBLIC HEALTH OF THE PEOPLE'S REPUBLIC OF CHINA and the
CHINESE ACADEMY OF MEDICAL SCIENCES, BEIJING
NOT FOR SALE Printed and distributed by the Regional Office for the Western Pacific of the World Health Organization Manila, Philippines
NOTE
The views expressed in this report are those of the par~i?ipants and members of the faculty of the tra1n1ng course and do not necessarily reflect the policies of the Organization
This report has been prepared by the Regional Office for the Western Pacific of the World Health Organization for governments of Member States in the Region and for the participants of the training course, which was held in Beijing, People's RepubHc of China from 30 August to 18 September 1982
CONTENTS
1.
INTRODUCTION 1.1 1.2 1.3
....................................................................................... ................................................................................. ..
1 1 1
Bac kground
Objectives
.................................................................................. ..
Review of previous courses held ln Wellington and Singapore (1980)
•••••••••••••
2 2 2 2
2.
CONDUCT OF THE COURSE 2.1 2.2 2.3
.. ...................................................................... .
Opening ceremony ...................................................................... .. Planning of the cours .............. "" .......... " .... "" .............. " ...... ..
'Local arrangements
...... " ................................................ ..
3 3 4 4 4
2.4 2.5 2.6 2.7
Scientific visits Soc is! progrannne Teaching methods Fi 1ms
••••.••••.•••..••................•• ......................................... . ............................. "" ....... ..
Practical exercises
.................................. .
2.R 2.9 2.10
.......................................................... .
Protocol development .......................... . Smoking prevention and community control ••••••••
4 5 5 6 6 6 6
3.
EVALUATION 3.1 3.2 3.3
........................................................ .
3.4 3.5 4.
Choice of participants by countries •••••..•••••.•••• Nomination of nonmedical scientists ••••••••••••••••• Faculty evaluation •••••••••••••••••••••••••••••••••• Duration of the course •...•.•.•••••.••.•••••.••.•••• Participants evaluation questionnaire Summary of key responses •.••.••••••.•.•..•••..••.•..
7 7
CONCLUSIONS
............................................... .
8
ANNEX 1 - FOLLOW UP OF PARTICIPANTS OF PREVIOUS COURSES ANNEX 2 - LIST OF PARTICIPANTS, OBSERVERS, FACULTY AND SECRETARIAT ANNEX 3 - TEACHING PROGRAMME
...............................
11
................................. ........................................... .......................................
13 19 25
ANNEX 4 - PROTOCOL PRESENTATIONS ANNEX 5 - EVALUATION QUESTIONNAIRE
....................................
27
1.
INTRODUCTION
1.1
Rackground
The developments that have taken place in the Region since the first WHO Regional Seminar on Cardiovascular Diseases due to Infections, particularly Rheumatic Heart Disease, Manila, November 1968, and the second Regional Seminar on the Prevention and Control of Cardiovascular Diseases, Manila, April 1975, have been considerable and can now be better evaluated. The acceptance by the Regional Director of the need for regional courses in epidemiology and community-based control of cardiovascular diseases led to the holding of the first course 1n Wellington in 1978 and the second in Singapore in 1980. The third regional course was held in Beijing, People's Republic of China in 1982. It came at a time when there is a much firmer data base of knowledge concerning the extent of cardiovascular disease problems within the Region and when community control is able to be considered in more practical terms. The broadening concepts of primary health care and the knowledge gained from some of the major intervention studies that have been or are being carried out in different parts of the world are making important contributions. The concepts of the comprehensive cardiovascular community control programmes (CCCCP) that are now being developed could provide a most valuable framework for real progresss within the Western Pacific Region, if they are properly developed. The appointment of a Regional Adviser in Cardiovascular Diseases in the WHO Regional Office for the Western Pacific, Manila, was an important step forward. The report of the 1980 CVD epidemiology course contained the conclusion that there would be advantages in holding the third course in China. This course was held in Beijing from 30 August to 18 September 1982. The advantages that can accrue to groups in the host country working in the field of cardiovascular diseases in epidemiology and biostatistics are real and for this reason the siting of the course is a matter requiring careful consideration by the Western Pacific Advisory Committee on Medical Research when making its recommendations to the Regional Director.
1.2
Objectives The objectives of the present course were to enable the participants: (1)
to understand the epidemiology and means of community-based control of cardiovascular diseases, with special reference to this Region; to apply statistical methods to cardiovascular epidemiology; to develop skills in order to prepare a research protocol for epidemiological studies of cardiovascular problems which could be developed on return to their own respective country;
(2)
(3)
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(4)
to develop a prevention and control programme on cardiovascular disease, including health services research strategies for tpsting and evaluating of such activity.
1.3
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Review of previous courses held in Wellington (lq78) and S· (1980) 1ngapore
A questionnaire was circulated in June 1982 to all participants who had taken part in the first and second regional training courses. They were asked to set out brief answers to questions relating to the benefits they had received and whether it had helped them in the development of further active involvement in fields of epidemiology and community prevention. A summary of the results and some comments have been prepared by Dr S. Hatano who was not involved in the 1978 or 1980 courses (see Annex 1).
2.
CONDUCT OF THE COURSE
2.1
Opening ceremony
The course was officially opened on 30 August 1982 by Professor Wu Jie-ping, Vice-President of the Chinese Academy of Medical Sciences, Reijing. Dr Zhou Min-jun, Deputy Director, Bureau of Sciences and Technology, Ministry of Public Health, was the main guest speaker at the opening ceremony held at the Meeting Hall of the Friendship Hotel, Beijing, the venue of the course. Professor Tao Shou-chi, Director of the Cardiovascular Institute and Fu Wai Hospital, Chinese Academy of Medical Sciences, acted as the Chairman of the opening session. Dr Santiago V. Guzman, WHO Operational Officer, spoke on behalf of the WHO Regional Director, Dr Hiroshi Nakajima, Manila. Dr Pepe T.S. Tuitama, participant from Samoa, Professor R. Brand of the University of California, Berkely, and Dr Ian Prior, Course Director, gave the responses on behalf of the participants and faculty of the course. The list of participants, observers, faculty and secretariat is given 1n Annex 2. 2.2 Planning of the course
The planning of the course programme had commenced in Singapore in 1980 and was continued by the members of the faculty in conjunction with the WHO Secretariat in the intervening period. The decision to hold the course over three weeks allowed provision for greater integration of the epidemiology and biostatistics sessions than was achieved in previous courses. Small group discussions within the class were used most effectively. These were used for retrospective reviews, exercises and
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other topics. The three weeks of the course can be seen to fall into the following main areas: First week: Second week: Third week: Introduction to epidemiology and biostatistics, including intervention studies and principles of community control The strategies for control and preparation of protocols Community intervention, presentation of protocols and smoking control programmes
2.3
Local arrangements
Professor Tao Shou-chi and his staff of the Cardiovascular Institute and Fu Wai Hospital, Chinese Academy of Medical Sciences; Dr Eric H.T. Goon, WHO Programme Coordinator, China, and staff of the WHO Regional Office in Manila; and officials in the Ministry of Public Health, Beijing, were responsible for the excellent local arrangements for the course. The facilities of the Peking Friendship Hotel Meeting Hall were good and accommodation costs very reasonable. 2.4 Scientific visits 8 September - Visit to the Capital Iron and Steel Complex, Beijing The main hospital was toured and their activities presented. There was emphasis on the baseline data on CVD among workers and the prevention and control programmes being undertaken as part of the major epidemiological programme of the Cardiovascular Institute and Fu Wai Hospital. The hospital is equipped with diagnostic and curative facilities for the workers up to the level of major general surgery. It serves a population of 60 000 workers. A health station was visited later in the afternoon. The health station is the peripheral unit which first looks into the health problems of the workers and members of their families. Emphasis was laid on prevention and control of communicable disease and maternal and child health. There are about twenty health stations in the whole Iron and Steel Complex. 11 September - Visit to Fu Wai Hospital This is a cardiovascular institute affiliated with the Chinese Academy of Medical Sciences. It is a 320-bed hospital headed by Professor Tao Sho-chi. The clinical services of the hospital consist of departments of medicine, surgery, radiology, anaesthesio10gy and a traditional medicine unit. For scientific studies, the Institute has research laboratories in the departments of physiology and biochemistry, pathology, pharmacology and nuclear medicine. The department of medicine has modern diagnostic facilities, including 2-D echo and a cardiac catheterization laboratory. The development of a programme of epidemiology and biostatistics over recent years was initiated by Professor Wu Ying-kai when he was Director and has been very actively carried forward by Professor Tao Shou-chi, who took over as Director in 1981. The Cardiovascular Institute has responsibilities at national level in terms of coordinating particular projects, playing a lead in standardization and development of epidemiological methods, and in training of younger people in epidemiology, biostatistics and community control of cardiovascular diseases.
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14 September - Visit to the Shijingshan People's Commune Health Centre The group visited the health centre in Shijingshan People's Commune as part of the afternoon activity. This commune is the base for epidemiological studies by the Fu Wai Hospital. The centre is staffed by a lay director and a number of doctors. Chinese traditional medicine as well as western medicine is used for treatment. Barefoot doctors are also part of the staff of the centre which serves a commune of about 6000 population mostly in relation to prevention and sanitation as well as the usual treatment of ordinary ailments. 2.5 Social programme
This was a highlight of the stay in Beijing, since it included the opportunity, both for the visitors and local participants in the course, to visit a variety of places of considerable interest and historical significance. A formal reception was given in honour of the participants by the Chinese Academy of Medical Sciences in the evening of 30 August. The group also visited the Great Wall, the Summer Palace, and other important places, including the tomb of Chairman Mao Tze-tung. The social programme also provided for some cultural exchanges, which fostered better working relationships during the course. The local hosts went to considerable length to help the visitors in more ways than one and the friendships developed in the group will help in future developments in the Region. 2.6 Teaching methods
The small group discussions within the lecture room during presentations and relating to particular questions were used more and appeared to offer some advantages, particularly for the epidemiology presentations and literature reviews. The participants were provided with a range of materials relating to the topic presentations and particular points in these were identified for special study. Overhead projectors were used for the majority of the presentations and have some advantages over slides. 2.7 Practical exerCLses
Exercises were undertaken in relation to age standardization, life table analysis, standardization of stroke criteria and sample size estimation in cross-sectional cohort and case control studies 2.8 Films
Films were shown on the history of hypertension and on new perspectives in atherosclerosis as well as on the use of exercises in rehabilitation in the People's Republic of China.
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2.9
Protocol development
A considerable effort was made by the faculty and participants in the aspect of the course as a learning exercise in protocol preparation. They were asked to develop protocols that addressed a certain critical question or questions relating to work in their country in this field of epidemiology and community control of cardiovascular diseases. The headings recommended as a means of systematizing their outlines were: (1) (2) (3) (4) (5) (6) (7) aims, principal question(s) to be asked; background and justification for study; study design and selection of subjects and sampling procedures; methods to be adopted for data collection and comparisons to be made; sources of bias; data collection and analysis plan; facilities, equipment needs, budget and staffing.
Fourteen protocols were prepared by the participants, the standard of which was good. The topics put forward and groups involved are set out in Annex 4. TWo participants developed a data analysis programme for studies they were involved with in their own countries and took advantage of advice from the faculty members relating to this. The protocols of some participants from the People's Republic of China were on a large scale and rather ambitious, and the long-term development of these will require considerable support and development if they are to be successful. 2.10 Smoking prevention and community control
Dr R. Masironi, Scientist, CVD Unit, WHO Headquarters, Geneva, and Professor S. Leeder of the University of Newcastle, Australia, joined the faculty during the third week of the course and were responsible for an excellent series of lectures on smoking prevention and community control techniques. The participants' presentations related to smoking patterns in the Region and programmes that could be further developed, including a much greater commitment by national governments to developing national goa is/strategies, including legislative measures. The WHO document Legislative action to combat world smoking epidemic (1982) by R. Roemer provided an excellent basis for these discussions.
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3.
EVALUATION
3.1
Choice of participants by countries
The quality of participants and observers was good, judging by their interest and understanding during the three weeks of the course. The background, training and seniority varied considerably and efforts were made to cater for this by grouping the participants and observers in small groups and by using peers to help explain issues causing difficulties. The mixed background and training of the participants also had many advantages and helped to bind the group together. 3.2 Nomination of nonmedical scientists
The development of epidemiology and community control of cardiovascular diseases in the Region must make full provision for the inclusion of scientists who are working in the field as nonmedical epidemiologists or are training in this field and for medical biostatisticians working with epidemiologists who can play an important role, and this must now be recognized by the WHO Regional Office in Manila. Progress in some countries will only take place if biostatisticians can be encouraged to work in the field of cardiovascular disease control; their involvement in the training courses would have real advantages. Selection of an epidemiologist in training and a hiostatistician from some group could allow data to be brought for discussion with the faculty members and could be used as a basis for practical exercises. ~n
These new directions concerning selection for the course are included the conclusions of this report (section 4). Faculty evaluation ~n
3.3
The programme was better planned than in previous courses and general went very well.
It required the full efforts of the faculty and a number of changes were made to deal with particular issues raised. The introductory sessions were not basic enough for some candidates and will need to be strengthened 1n the next course to meet this acknowledged need of participants who are at different levels of understanding. The development of protocols again formed an important feature of the course and is likely to have a number of advantages to the Region. The balance of more formal presentations, exercises and protocol development flowed well and the majority of the participants applied themselves well to the ways of learning experiences that were provided.
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3.4
Duration of the course
The faculty was asked whether the course should be three or two weeks' duration. It was felt that this could vary depending on the background and training of the participants expected to attend. Discussion will continue with the faculty and the WHO Regional Office in Manila, and participants' responses will be considered. A case could be made for the three-week course when the majority of the participants have not had much involvement in the field. They would benefit considerably if the interchange and exchange of work and analysis programmes could be enhanced and developed in the Region. In general the balance of the course appeared reasonable. Weekly review sessions provided an excellent forum for favourable comments regarding aspects of each week's programme. The faculty members could then take these into account. 3.5 Participants evaluation questionnaire - Summary of key responses
Twenty-one participants and observers returned the unsigned questionnaire (see Annex 5). A summary statement of certain of the questions is set out. Course objectives All felt the course had achieved the objectives set out. Replies concerning lecture sessions Subjects
Very Useful
5 Epidemiology Biostatistics Prevention Community control Smoking Practical work Protocol
4 6 5 8 8 10 4 8
3
Useful 2
Not useful 1
13 14 8 7 7 8 11
2 2
5 6 3 7 2
Other detailed answers from participants will be considered by the faculty in the planning of future courses.
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4.
CONCLUSIONS
4.1 Tt was con9idpr~d that R further traInLng course in eridemiology and community-based control of cardiovascular diseases should be planned for 19 Rtf.
4.2
Participants
It was considered that such training course should in future be also open to nonmedical graduates in training in epidemiology or biostatistics as there will be an increasing need for such persons in the multidisciplinary teams required for effective programmes in cardiovascular disease control. For example, it would be desirable for a country to send a pair of trainees consisting of one medically trained and one statistically trained participants, who could be expected to work together as a team on subsequent projects. 4.3 The provision of research and tra1n1ng fellowships in epidemiology, biostatistics and community control of cardiovascular diseases should be encouraged through WHO/Regional Office for the Western Pacific and other organizations. The selection of suitable candidates, the duration of training needed in overseas institutions, and their placement should be carefully considered if the greatest benefit is to be gained for the persons involved and their home country. 4.4 Efforts should be continued to gain support from non-WHO funding sources such as national heart foundations or national medical research councils for a limited number of observers as a way of widening support for the importance of training in the Region. This would also enhance collaboration in the Western Pacific Region of WHO. 4.5 Site of the proposed 1984 course
It was considered that Malaysia could be a suitable country for the next course if the Government and the WHO Regional Office would favourably consider this suggestion. The Institute for Medical Research (IMR) in Kuala Lumpur might be a good site for the course; reasonable hostel or hotel accommodation is said to be available. As alternative site would be a centre in a rural area, which would have some advantages. 4.6 It was considered that certain advantages accrue to the host country both during and after the course, and it is important that the siting of the course should fit in with the general philosophy and strategies of the host country relating to epidemiology and community control of cardiovascular diseases as part of its overall programme oriented towards health for all in the year 2000. The Beijing 1982 course has incorporated improvements developed by the faculty since 1978 and 1980 courses, taking into account the needs of the Region and some comments of the participants and the influence which the course has had on some participants in the previous courses.
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It was considered that the faculty for the present course (Dr Prior, Dr Beaglehole, Dr Hatano and Professor Brand) should be asked to take part 1n the 1984 course and be given notice as soon as is reasonable. 4.8 It was considered that copies of this report should be circulated to all those who attended the two previous courses in Wellington, 1978 and Singapore, 1980 in addition to the normal distribution.
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ANNEX 1
FOLLOW-UP OF PARTICIPANTS OF PREVIOUS COURSES An inquiry letter was sent to all the participants of the two previous courses in order to get feedback and information to help assess the effectiveness of the course (see questionnaire in Appendix 1). Ten participants out of 19 in the 1978 course and 10 participants out of 25 (21-WPRi 4-SEAR) in the 1980 course replied. The answers are summarized in Table 1. Replies from the participants in the two previous courses are broadly similar. About one half of the participants are working in clinical medicine and the other half in epidemiology. Current involvement in epidemiology is determined by the type of work and it is clearly difficult for busy clinicians to initiate or carry out epidemiological studies which require time and manpower. One-third found the course to have been very useful and one-third acknowledged its usefulness. One did not reply. Three replied that it was useful, but two complained that pressures of work prevented them from being able to apply their interest and knowledge in epidemiology. One felt that the contents of the course were being learnt anyway during his career as an epidemiologist. Table 1 - Summary of replies from participants Participation in 1978 1980 Type of present work mostly clinical mostly epidemiology administrative Current involvement 1n epidemiology yes no Judgement of usefu1ness of the course 1n retrospect very useful useful useful but not useful no answer
1978 + 1980
6
6 5 1
5 2
12 10 3 12 13
6
7
6 6
3
4
5 4 1
o 1
2
o o
o 1
8 8 3
- 12 Annex 1
A professor in clinical medicine felt the course to be a good introduction to epidemiology. A professor in public health appreciated the opportunity the course offered to broaden her contact with foreign reseachers. The courses have been most appreciated by both clinicians and epidemiologists in training who are working actively in their own field and who have their own problems. The course was interesting and stimulating and helped them pinpoint their research interest, provided them with modern methodology, and gave community and preventive perspectives. The course has an important role in exposing clinicians who work at a regional hospital or in a community, in helping them to make a community diagnosis, and supplying basic ideas for prevention. The majority, however, are frustrated with busy daily clinical services, which prohibit them from developing epidemiological studies. It is hoped, however, that this training in epidemiology would remain as a potential to revive and start some epidemiological work as soon as there appears an opportunity. For participants with moderate training, the course provided the most benefit, consolidating their interest and thinking, offering wider perspectives and methodology and improving the quality of their research and prevention strategy. Although it may be premature to evaluate this aspect, promotion of international communication and exchange of ideas between investigators within the Region are other benefits of the course. For a senior investigator, the course was still a good opportunity to be exposed to what is occurring in the Region and to meet investigators from other countries for possible future cooperation. Participants with varying degrees of training will also benefit from the course. Selection of participants, however, needs to be carefully made. If they have no opportunity to develop their programme by using the knowledge gained during the course, the course may be largely wasted. It should, however, be noted that this is an early follow-up only and effects of education should be judged on long-term basis. It is clearly going to be of very real advantage to certain people. As the gradual spread and accumulation of epidemiological methodology and interest develop these participants can be expected to contribute as a core group to the development of community programmes in the Region.
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ANNEX 2
LIST OF PARTICIPANTS, OBSERVERS, FACULTY AND AUSTRALIA
S~;CRF.TARIAT
Dr R. C. Copeman Medical Officer Durri Aboriginal Medical Service P.O. Box 117 West Kempsey, NSW 2440
CHINA
Dr Feng Rongguan Associate Professor First Affiliated Hospital China Medical College Shenyang Dr Ren Liqin Jr Visiting Doctor of Internal Medicine Department of Cardiology Second Hospital, Lanzhou Medical College Lanzhou, Gansu
Dr WU Xiqui Cardiologist-Attending Physician Department of Medicine Cardiovascular Institute and Fu Wai Hospital Chinese Academy of Medical Sciences Beijing Dr Yao Chunghua Heart, Lung and Blood Vessel Medical Center 8 Baijazhong Road Chaoyang District Beijing FIJI
Dr Mirza Firoze Beg Consultant Physician Colonial War Memorial Hospital Suva Dr Mitsuru Fujii Medical Officer Health Statistics Division Statistics and Information Department Ministry of Health and Welfare Japanese Government 1-2-2, Kasumigaseki, Chiyoda-ku Tokyo 100
JAPAN
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Annex 2
Dr Shin Izumiyama Medical Officer and Deputy Director, Handicapped Persons Welfare Division Ministry of Health and Welfare Japanese Government 1-2-2, Kasumigaseki, Chiyoda-ku Tokyo 100 MALAYSIA Dr Saimy (alias Saman) bin Ismail Heal th Officer Rural Health Training School Rembau, Negeri Sembilan Dr Ng Tian Seng Physician General Hospital Ipok, Perak NEW ZEALAND Dr Ruth Bonita Beaglehole Research Officer Department of Medicine School of Medicine University of Auckland Private Bag Auckland Dr Tomas Dequifta Medical Specialist II Bureau of Health Services Ministry of Health Sta. Cruz, Manila Dr Jaime S. Vizcayno Junior Scientist Philippine Heart Center for Asia East Avenue Quezon City SAMOA Dr Pepe T.S. Tuitama Chief Physician Head, Medical Unit Samoa National Hospital Alafua, Apia Dr Chen, Ai Ju Director, Research and Evaluation Unit Ministry of Health Cuppage Centre, Cuppage Road Singapore 0922
PHILIPPINES
SINGAPORE
- 15 Annex 2
2. CHINA
OBSERVERS
Dr Pan Xin wei Shanghai First Medical College Dr Zhai Shangda Shanghai Second Medical College Dr He Huiming Provincial Institute of Cardiovascular Diseases Guangzhou, Guangdong Province Dr Chen Dan Yang Chao Yang Hospital Beijing Dr Xiao Shikui Fuwai Hospital Chinese Academy of Medical Sciences Beijing Dr Pan Xiaoqin Wuhan Medical College Hubei Province Dr Zhang Xianggu Hospital of Capital Iron and Steel Company Beijing Dr Xu Xianglin Shanxi Province Dr Wang Jihua Tianjin Medical College Dr Zhen Tong
Zhejiang Medical University NEW Zealand CONSULTANT! COURSE DIRECTOR Dr Rodney Thornton Jackson National Heart Foundation of New Zealand Dr Ian Prior (Epidemiologist) Director, Epidemiology Unit Wellington Hospital Private Bag Wellington, New Zealand
- 16 Annex 2
TEMPORARY LECTURER
Professor Stephen R. Leeder Department of Community Medicine University of Newcastle Newcastle, N.S.W. 2308 Australia Professor Robert Beaglehole (Epidemiologist) Department of Community Medicine School of Medicine University of Auckland Private Bag Auckland, New Zealand Professor Richard Brand (Biostatistic ian} Department of Biomedical and Environmental Health Sciences School of Public Health University of California Berkeley, California 94720 United States of America Dr Shuichi Hatano (Epidemiologist) Head, Department of Epidemiology Tokyo Metropolitan Institute of Gerontology 35-2 Sakaecho, Itabashi-ku Tokyo 173, Japan Professor Wu Ying-kai Heart, Lung and Blood Vessels Medical Center 8 Baijazhong Road Chaoyang District Beijing People's Republic of China 4. SECRETARIAT
WHO TEMPORARY ADVISER I LECTURERS
Dr E.H.T. Goon WHO Programme Coordinator World Health Organization United Nations Building 2 Dongqijie, Sanlitun Beijing People's Republic of China Dr Santiago V. Guzman (WHO Operational Officer) Consultant, CVD Unit WHO Regional Office for the Western Pacific Manila Philippines
- 17/18 Annex 2
Dr Roberto Masironi Scientist, CVD Unit WHO Headquarters Geneva, Switzerland Professor Tao Shou-chi (Local Coordinator) Director, Cardiovascular Diseases Institute and Fu Wai Hospital Chinese Academy of Medical Sciences Beijing People's Republic of China Mr Marcelo Medina Secretary, CVD Unit WHO Regional Office for the Western Pacific Manila Philippines
*Also Faculty Member/Lecturer.
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ANNEX 3
TEACHING PROGRAMME First week Monday, 30 August 9:00 - 10:00 a.m. 10:00 - 11:30 a.m. 11:30 - 12:30 a.m. 2:00 3:30 p.m. Opening ceremony Overview of course and its development Introduction to epidemiology and biostatistics The magnitude and nature of cardiovascular disease problems with special reference to the Western Pacific Region Rates and age adjustment with illustrations from the Region I. Prior R. Beag1eho1e R. Brand
R. Beag1eh01e R. Brand
4:00 -
5:00 p.m.
Tuesday, 31 August 8:30 - 10:00 a.m. Natural history of cardiovascular disease in the Pacific - coronary heart disease - stroke - hypertension - rheumatic heart disease Statistical methods. Strategies for different types of studies Current issues and controversies in epidemiology including use of registries - coronary heart disease - hypertension Current 1ssues and controversies 1n - smoke - rheumatic fever and rheumatic heart disease Statistical methods for analysis of registry data. Introduction to life tables. Loss to follow-up effect on incidence. New cases and their outcome
R. Beag1eho1e S. Hatano 1. Prior S. Guzman R. Brand
10:30 - 11:30 a.m. 11:30 - 12:30 a.m.
s.
Hatano
R. Beag1eho1e
2:30 -
3:30 p.m.
S. Hatano 1. Prior
4:00 -
5:00 p.m.
R. Brand
- 20 Annex 3
Wednesday, 1 Septemher 8:00 - 10:00 a.m. 10:00 - 11:30 a.m. Strategies for risk factor research Epidemiological studies - cross sectional - cohort - case control Exercise. Regional data analysis of country mortality Sample s~ze
R. Brand R. Beagleho1e
11: 30 - 12:30 a.m. 2:30 4.00 3:30 p.m. 5:00 p.m.
requirements Exercise on adjustment
Small group discussion.
Thursday, 2 September 8:30 - 10:00 a.m. 10:30 - 11:30 a.m. 11:30 - 12:30 a.m. 2:30 3:30 p.m. Sampling s~ze
examples
R. Brand R. Brand
Mu1tifactora1 studies Regional data presentations by four groupings Design of epidemiological studies and priority questions for var~ous countries in the Region Literature discussion
4;00 -
5:00 p.m.
Friday, 3 September 8:30 - 10:00 a.m. 10:00 - 11;30 a.m. 11:30 - 12:30 a.m. 2:30 4;00 3;30 p.m. 5:00 p.m. Presentation of priority questions in the Region Epidemiological studies in the People's Republic of China County presentations Study design and protocol development Review of the week R. Beagleho1e
Tao Shou-chi
- 21 Annex 3
Second week Monday, 6 September 8:30 - 10:00 a.m. 10:00 - 11:30 a.m. Intervention studies, including clinical trials Quantification of community control, including look at some quantification of screening vs community approach Exercise. Blood pressure measurement 1. Prior
R. Beaglehole
R. Brand
11:30 - 12:30 a.m. 2:30 4:00 3:30 p.m. 5:00 p.m.
Exercise. Intervention individual variations Film. History of hypertension
R. Brand
Tuesday, 7 September 8:30 - 10:00 a.m. 10:30 - 11:30 a.m. 11:30 - 12:30 a.m. 2:30 4:00 3:30 p.m. 5:00 p.m. Health serV1ces research, including clinical trials Literature review Attributable risk efficiency and effectiveness Protocol session. questions Statement of ma~n
R. Beaglehole R. Beaglehole
R. Brand
Sample size for intervention studies -
R. Brand
Wednesday, 8 September 8:30 - 10:00 a.m. 10:30 11 :30 2:00 11:30 a.m. 13:30 a.m. 5:00 p.m. community control of cardiovascular disease Protocol presentation. Session 1 Wu Ying-kai R. Beaglehole
Community-based control programme in the People's Republic of China Field trip. Visit to the capital Iron and Steel Complex
- 22 Annex 3
Thursday, 9 September 8:30 - 10:00 a.m. 10:30 11: 30 11 :30 a.m.
Lifestyle and changes Review of all exercises Protocol presentation. Protocol presentation. Primary health care and Session 2 Session 3
R. Beag1ehole S. Hatano
-
12:30 a.m. 3:30 p.m. 5:00 p.m.
2:30 4:00 -
Professor Chen Wen-ch ieh
Friday, 10 September 8:30 - 10:00 a.m. 10:00 Protocol presentation. Session 4
-
11: 30 a.m.
Review of health education and health promotion in the Region. Small group discussions Participant presentations of work being undertaken Review of week and Open forum
11:30 - 12:30 a.m. 2:30
-
4:00 p.m.
Third week Monda;t, 13 September 8:30
-
10:00 a.m.
Primordial prevention Participant presentations Multiple risk factor intervention Hypertension in the Region & S. Pacific Problems in assessment of trends in risk factors in face of interventions
S. Leeder
10:30 - 11: 30 a.m. 11:30 - 12:30 a.tn. 2:30 3:30 p.m.
R. Brand
s.
Hatano
R. Brand R. Beaglehole S. Leeder
4:00 -
5:00 p.m.
Major intervention trials Mild hypertension trial in Australia -
- 23/24 Annex 3
Tuesday, 14 September 8:30 - 10:00 a.m. 10:30 - 11:30 a.m. 2:00 5:00 p.m. Rheumatic fever and rheumatic heart disease in the Region Protocol presentations by participants Field trip. Visit to the health centre of Shijingshan People's Commune and their community S. Guzman I. Prior
Wednesday, 15 September 8:30 - 10;00 a.m. 10;30 Protocol presentations Criteria and end-points in CVD Protocol presentations Protocol presentations Smoking prevention and control Harmful effects of smoking, CVD pathology and passive smoking - WHO position Thursday, 16 September 8:30 - 10:00 a.m. 10:30 - 11:30 a.m. 11:30 - 12;30 a.m. Review of epidemiology of smoking patterns in the Region Smoking cessation in high risk subjects Preparation of goals and strategies for smoking control by participants relating to their countries Afternoon free Friday, 17 September 8;30 9:00 10;00 12;00 R. Beaglehole S. Leeder Moderator R. 8eag1eho1e S. Hatano
-
11: 15 a.m.
11 :15 - 12:30 a.m. 2:30 4:00 3:30 p.m. 5:00 p.m.
-
R. Masironi
-
9:00 a.m. 10:00 a.m. 12:00 a.m. 12:30 a.m.
Final evaluation questionnaire Review of the week Review of course and faculty recommendations Closing ceremony
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ANNEX 4
PROTOCOL PRESENTATIONS 1. Cohort study of risk factors of cardiovascular diseases among the steel workers at the Capital Iron and Steel Complex. - Dr Wu Xiqui Beijing, China 2. Why Australian aborigines seem to have a high prevalence of hypertension - Dr Robert Copeman Australia 3. Auckland coronary heart disease risk factor prevalence study - Dr Rodney T. Jackson New Zealand 4. Is smoking a risk factor of stroke in China? - Dr Zai Shangda Shanghai, China 5. Primary intervention of hypertension, stroke and ischaemic heart disease in the Capital Iron and Steel Complex area - Dr Zhang Xionggu Beijing, China 6. What is the pattern of occurrence of cerebrovascular diseases (stroke) in New Zealand? - Dr Ruth Bonita Beaglehole Auckland, New Zealand 7. What is the incidence rate of cardiovascular diseases in Samoa? - Dr Pepe T.S. Tuitama Western Samoa 8. What is the effect of the community cardiovascular disease programme in Singapore on morbidity and mortality of CHD and CVD? - Dr Chen Ai Ju Singapore 9. What is the magnitude of hypertension in Malaysia? - Dr Ng Tien Seng Malaysia
- 26 Annex 4
10.
What is the relationship of the blood pressure intervention programme to stroke? The evaluation of a blood pressure intervention programme - Dr M. Fujii Japan
11.
The MONICA project examlnlng changing patterns of CHD and CVD in a Chinese community in Beijing to include CHD and stroke - Drs Yao Chung hua & Pan Ziaoquin Beijing, China
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ANNEX 5
EVALUATION QUESTIONNAIRE Please do not withhold your comments, the Faculty want honest criticism. 1.
Do you remember the objectives of the course Did you achieve these objectives If not, specify areas of failure
Yes Yes
No No
2.
3.
In future courses do you think the proportion of teaching strategic should be: LECTURES Reduce Same Increase TIME FOR PERSONAL STUDY Reduce Same Increase PRACTICAL Reduce Same Increase HANDOUTS Reduce Same Increase GROUP DISCUSSION Reduce Same Increase
4.
Assessment of different broad sections of the course - please ring ranking number on scale 5 to 1 Very useful Epidemiology lectures Overall assessment Comment Biostatistical lectures Overall assessment Comment Prevention lectures Overall assessment Comment 5 5 5
Useful
Not useful
4
3
2
1
4
3
2
1
4
3
2
1
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Very useful Community control lectures Overall assessment Comment Smoking workshop Overall assessment Comment 5. 5 4 5 4
Useful
Not useful
3
2
1
3
2
1
Practical work Overall assessment Comment Protocol preparation Overall assessment Comment 5 4 3
5
4
3
2
1
2
1
What areas do you feel should have received more emphasis in practical work Simple statistics Literature discussions Yes Yes No No Uncertain Uncertain
Epidemiological exerC:lses such as work on screening and testing efficiency Yes and effectiveness Other areas
No
Uncertain
-
spell out
6.
Other sessions Comment
7. 7.1 7.2
General comments What was the most disappointing feature of this course? What project or projects do you hope to commence or take part in in your country?
- 29 Annex 5
7.3
What difficulties do you expect?
7.4
Organization of meeting
Good
Average
Poor
Please set out comments that would hlep with organization of future courses.
8.
Do you think future courses on epidemiology and the community-based control of cardiovascular diseases should be:
10 days 14 days 3 weeks Comment
8.1
Are there biostatisticians in your country able to help with cardiovascular epidemiology? Yes No Are they available to help you? Yes No
8.2
Are there biostatisticians who could take part in a special training course in statistics and data processing for cardiovascular epidemiological studies? Yes No Don't know
List not more than three useful experiences during the last three weeks.
Please state why they were useful.
List not more than three unsatisfactory experiences during the last three weeks.
Please state why they were unsatisfactory.
Would you like to make any suggestion for the future conduct of this workshop?