The Developing Role of Systems of Competences in Public Health Education and Practice

In recent decades there have been attempts in many professions to define the competences of their practitioners. Over the last quarter century attempts have been made to apply this to public health; initiatives in several countries have been devised to meet the perceived needs of public health education and training (e.g., the United States), of public health practice (e.g., the United Kingdom), etc. The achievements and some of the failings of US and UK initiatives are reviewed.Since 2006 The Association of Schools of Public Health in the European Region (ASPHER) has been working on a system of public health competences suited and adapted to the needs of both public health education and training, and practice. After much work and several stages of development, a third series of competence lists (for public health practitioners generally, for MPH-related education, and for employment purposes) will soon be published. ASPHER believes that for sus­tainability of a competences project, the competences proposed must be seen as relevant by all public health practitioners and stakeholders, including those engaged in education and training, service work, and public health research. Accordingly, all these stakeholders need to be involved in the preparation of lists of competences.Sustainability will also require an ongoing system and structure for permanent review of existing public health competences, and of the need for definition of new ones. Possible directions towards the achievement of this are indicated. A generally accepted system of core competences could contribute most to the establishment of a clearly identifiable public health profession across Europe, equipped to address current and future health needs of its peoples.All three experiences described share similar challenges, and on a continuing basis these will of necessity need to be addressed in the future: the assessment of whether competences have been achieved or not; the evaluation of whether lists of competences are genuinely appropriate both to population health challenges and to the development and management of systems of intervention as experienced in practice; identification of appropriate means to take account of geographical, regional and national disparities within one common competence system

Persistent urinary incontinence and delivery mode history: a six-year longitudinal study.

Objective: To investigate the prevalence of persistent and long term postpartum urinary incontinence and associations with mode of first and subsequent delivery. Setting: Maternity units in Aberdeen (Scotland), Birmingham (England) and Dunedin (New Zealand). Design: Longitudinal study Population: 4214 women who returned postal questionnaires 3 months and 6 years after the index birth. Methods: Symptom data were obtained from both questionnaires and obstetric data from case-notes for the index birth and the second questionnaire for subsequent births. Logistic regression investigated the independent effects of mode of first delivery and delivery mode history. Main outcome measures: Urinary incontinence – persistent (at 3 months and 6 years after index birth) and long-term (at 6 years after index birth). Results: The prevalence of persistent urinary incontinence was 24%. Delivering exclusively by Caesarean section was associated with both less persistent (OR= 0.46, 95% CI 0.32 to 0.68) and long term urinary incontinence (OR=0.50, 95% CI 0.40 to 0.63). Caesarean section birth in addition to vaginal delivery however was not associated with significantly less persistent incontinence (OR 0.93, 95%CI 0.67 to 1.29). There were no significant associations between persistent or long-term urinary incontinence and forceps or vacuum extraction delivery. Other significantly associated factors were increasing number of births and older maternal age. Conclusions: The risk of persistent and long term urinary incontinence is significantly lower following Caesarean section deliveries but not if there is another vaginal birth. Even when delivering exclusively by Caesarean section, the prevalence of persistent symptoms (14%) is still high

Prevalence of urinary incontinence in Andorra: impact on women's health.

BACKGROUND: Urinary incontinence (UI) is a frequent public health problem with negative social consequences, particularly for women. Female susceptibility is the result of anatomical, social, economic and cultural factors. The main objectives of this study are to evaluate the prevalence of UI in the female population of Andorra over the age of 15 and, specifically, to determine the influence of socio-demographic factors. A secondary aim of the study is to measure the degree of concern associated with UI and whether the involved subjects have asked for medical assistance, or not. METHODS: Women aged 15 and over, answered a self-administered questionnaire while attending professional health units in Andorra during the period November 1998 to January 2000. A preliminary study was carried out to ensure that the questionnaire was both understandable and simple. RESULTS: 863 completed questionnaires were obtained during a one year period. The breakdown of the places where the questionnaires were obtained and filled out is as follows: 32.4% – medical specialists' offices; 31.5% – outpatient centres served exclusively by nurses; 24% – primary care doctors' offices; 12% from other sources. Of the women who answered the questionnaire, 37% manifested urine losses. Of those,45.3% presented regular urinary incontinence (RUI) and 55.7% presented sporadic urinary incontinence (SporadicUI). In those women aged between 45 and 64, UI was present in 56% of the subjects. UI was more frequent among parous than non-parous women. UI was perceived as a far more bothersome and disabling condition by working, middle-class women than in other socio-economic groups. Women in this particular group are more limited by UI, less likely to seek medical advice but more likely to follow a course of treatment. From a general point of view, however, less than 50% of women suffering from UI sought medical advice. CONCLUSION: The prevalence of UI in the female population of Andorra stands at about 37%, a statistic which should encourage both health professionals and women to a far greater awareness of this condition