Background: Data on individual risk factors for chronic diseases (smoking, physical activity, body mass) are collected by company physicians in heterogeneous ways. This makes comparisons, researches and evaluations difficult. Objectives: The aim of the study was to find a consensus on evaluation tools for chronic diseases risk factors and for health promotion programs in workplaces that could be performed by company physicians during their clinical activity. Methods: A first set of tools, proposed by a working group of occupational physicians in Bergamo, was submitted through the Delphi technique to a national expert panel of 22 persons including recognized national experts in specific fields and occupational physicians skilled in health promotion. Results: In three Delphi rounds, the panel selected a set of tools to monitor the main individual risk factors for chronic diseases (smoking, alcohol, physical activity, nutrition, stress and mental health) as well as general data related to the worker and his job. Conclusions: The use of these specific tools, collected in a homogeneous format, should be recommended to all Italian company physicians, in particular those who work in WHP-programs, in order to allow analysis, comparison and evaluation of health promotion programs effectiveness at a national level.

La penurie de main-d'œuvre de sante publique competente represente au niveau mondial un probleme majeur. La situation est particulierement difficile en Afrique sub-saharienne. En 2008, l'Organisation Mondiale de la Sante et de la Global Health Workforce Alliance a lance un appel a propositions pour un programme de formation en sante publique mettant l'accent sur le developpement des personnels de sante et ciblant specifiquement l'Afrique. Notre article presente l’elaboration, la mise en œuvre et l'evaluation d'une Maitrise d’Etudes avancees en sante publique. Le projet a ete developpe en collaboration avec des etablissements universitaires partenaires de dix pays africains francophones et bureaux locaux, le bureau regional et le HQ de l'OMS.

Contexte. La penurie de main-d'oeuvre de sante publique competente represente au niveau mondial un probleme majeur. La situation est particulierement difficile en Afrique sub-saharienne. En 2008, l'Organisation Mondiale de la Sante et de la Global Health Workforce Alliance a lance un appel a propositions pour un programme de formation en sante publique mettant l'accent sur le developpement des personnels de sante et ciblant specifiquement l'Afrique. Notre article presente l’elaboration, la mise en oeuvre et l'evaluation d'une Maitrise d’Etudes avancees en sante publique. Le projet a ete developpe en collaboration avec des etablissements universitaires partenaires de dix pays africains francophones et bureaux locaux, le bureau regional et le HQ de l'OMS.

Background: Colorectal cancer screening may reduce disease-related mortality by early-stage detection of cancers.Aims: To study the effect of a single immunochemical faecal occult blood test (i-FOBt) screening round on reduction in colorectal cancer-related-mortality among average risk subjects.Methods: Comparison of 5-year mortality rates in 3 cohorts from a Northern Italian province: (1) colorectal cancers detected at the 1st biennial round of a mass-screening programme targeting 50-69 years old subjects, (2) non-screening cancers symptomatically diagnosed during the same time period, and (3) cancers detected in the pre-screening biennium. Multivariate analyses were performed with the Cox regression model including tumour node metastasis (TNM) stage at diagnosis, anatomical distribution of cancers, age at diagnosis, gender and patient group. Kaplan-Meyer survival estimates and log-rank test for equality of survivor functions were calculated.Results: Stage distribution significantly differed between screening and non-screening colorectal cancers: 73% of screen-detected colorectal cancers were stages I and II versus 43% and 40% of non-screening and pre-screening colorectal cancers. Cumulative 5-year mortality rate was significantly lower in screening compared to non-screening or pre-screening colorectal cancers patients (19% versus 37% and 41%, p < 0.001).Conclusions: Colorectal cancers were detected at earlier stages in i-FOBT-positive subjects in comparison with non-screening patients; colorectal cancers found at screening had a significantly improved 5-year survival. (C) 2014 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

BACKGROUND:Shortage of a competent public health workforce is as a worldwide problem. The situation is especially bad in sub-Saharan Africa. In 2008, the World Health Organization and the Global Health Workforce Alliance launched a call for proposals for a public health training programme with an emphasis on health workforce development specifically targeting Africa. Our article presents the development, implementation and evaluation of an e-learning Master of Advanced Studies in Public Health on Workforce Development. The project was developed in collaboration with academic partner institutions of 10 French-speaking African countries and local/regional/HQ WHO offices.METHODS:A five-step approach was adopted. First, a needs assessment study was done in the target countries, with identification of priority health issues. Second, student and tutor selection was done in collaboration with local WHO offices, health authorities and partner universities. Third, the e-platform was developed and a training workshop for tutors was organized. Fourth, the learning objectives were derived from the needs assessment study and an interactive educational approach was adopted. Fifth, the participation of students, their perception of the programme, their performance on assignments and community outcomes were monitored.RESULTS:The needs assessment allowed the identification of 12 priority health issues (trauma related to road accidents, maternal and child health, HIV/AIDS, mental heath, food and malnutrition, health resource management, infectious diseases, access to essential drugs, chronic diseases, health promotion, ageing and violence/conflicts) of which 10 were studied through the lens of the key public health disciplines (epidemiology, human resources, health project/service planning, health policy, communication, health economics/management, informatics and ethics/human rights), each validated through a certifying examination. Student participation, measured through connection hits (total: 58 256; mean: 168/student/module) and posted messages (total: 5994; mean: 18/student/module), was good, and global satisfaction was high (7.7/10). Twenty-nine students out of 37 obtained their master's degree from the University of Geneva. Outcomes reported include career development, strengthening of inter-country networks and common projects.CONCLUSIONS:Keys to the success of the programme were the enthusiasm and commitment of students, the availability of the coordination team, the simplicity of the electronic platform and the support of local/regional/WHO offices. Yet, the sustainability of the programme is not assured.

In 2006, WHO alerted the world to a global health workforce crisis, demonstrated through critical shortages of health workers, primarily in Sub-Saharan Africa (WHO in World Health Report, 2006). The objective of our study was to assess, in a participative way, the educational needs for public health and health workforce development among potential trainees and training institutions in nine French-speaking African countries. A needs assessment was conducted in the target countries according to four approaches: (1) Review at national level of health challenges. (2) Semi-directed interviews with heads of relevant training institutions. (3) Focus group discussions with key-informants. (4) A questionnaire-based study targeting health professionals identified as potential trainees. A needs assessment showed important public health challenges in the field of health workforce development among the target countries (e.g. unequal HRH distribution in the country, ageing of HRH, lack of adequate training). It also showed a demand for education and training institutions that are able to offer a training programme in health workforce development, and identified training objectives and core competencies useful to potential employers and future trainees (e.g. leadership, planning/evaluation, management, research skill). In combining various approaches our study was able to show a general demand for health managers who are able to plan, develop and manage a nation’s health workforce. It also identified specific competencies that should be developed through an education and training program in public health with a focus on health workforce development.

Introduction Colonoscopy workload for endoscopy services in Western countries is increasing markedly because of the implementation of faecal occult blood-based mass screening programmes against colorectal cancer (CRC). We therefore explored the possibility of using a combination of faecal tests to prioritize the access to colonoscopy with criteria other than symptoms and/or time of referral. Aims and methods We tested a combination of faecal tests [immunochemical faecal occult blood test (i-FOBT), M2-PK, calprotectin] as markers for advanced neoplasia in a selected series of patients requiring colonoscopy for the suspicion of CRC. All the tests were performed in a 1-day stool sample of patients aged 50–80 years, without any dietary restriction, before colonoscopy. Results A total of 280 patients’ stool single samples were analysed. Forty-seven patients had CRC and 85 patients had one or more advanced adenoma(s) at colonoscopy/histology. CRCs were associated with a highly significant increase (P<0.001) in faecal tumour M2-PK (mean 24.2 kU/l), which correlated with Dukes’ staging. For CRC detection, i-FOBT was the test with the highest specificity and positive predictive value (0.89 and 0.53), whereas M2-PK had the highest sensitivity and negative predictive value (0.87 and 0.96). Calprotectin showed performance similar to M2-PK in terms of sensitivity and negative predictive value (0.93), but had lower specificity (0.39). The best combination of tests to predict the risk of CRC in this series was i-FOBT+M2-PK, as in patients showing positivity to both markers, the risk of cancer was as high as 79%. Conclusion The combination of i-FOBT and M2-PK is a sensitive tool in clinical practice for the appropriate management of waiting lists for colonoscopy, as it allows the classification of patients into different degrees of priority for investigation, according to their foreseeable risk of CRC.

Interventions for health promotion in the workplace (WHP programs) can improve the health of workers, acting on modifiable risk factors for chronic diseases. The effectiveness of integrated programs of health promotion in companies is well described in literature. Our project was conducted in two mid-sized companies in the province of Bergamo, respectively with 170 and 230 employees. The project issues were in the following areas: tobacco smoke (awareness and support to smoking cessation); nutrition (awareness and practical action on the workplace canteen); physical activity (awareness, information and practical ways of incentives); prevention of road accidents (training and initiatives to promote safety). The analysis of the behaviours and individual risk factors was performed by a questionnaire at the beginning of the project and a year later. 95 initial questionnaires were returned and processed for the company A and 168 for the company B; their results were discussed with company management, the company doctors and workers representatives and allowed the formulation of a "company assessment risk profile" according to the methodology of the Assessment of Health Risks with Feedback (AHRF). There have been training/awareness messages in working hours for all employees on areas of lifestyle and have started work on the canteen, actions to promote road safety, physical activity and interventions to counter the smoking. The effectiveness of group treatments for smoking cessation has been of 55.6% at 3 months and 50% at 6 months (at the present only a company has achieved 6 months of follow up).