2. 2
Acknowledgement
First I would like to thank Mrs Daiga Behmane, Director of Health Management study
programme, RSU, Iveta Ludviga also program Director of RISEBA, and Iveta Pudule, Senior
Public Health Analyst, Centre for Disease Prevention and Control, for giving me the
opportunity to do an internship within the organization. For me it was a unique experience to
be in such a knowledge and professional environment. I also want to thank Toms Pulmanis,
Head of Mental Health Promotion Unit, Centre for Disease Prevention and Control, for
guiding me through this complete internship step by step, clearing all my doubts and making
me understand. I also would like to thanks all the staffs who was working there as, though I
was an international student they were helping me to complete my internship successfully
and more over though language was a barrier every person was coordinating with the
language which I was comfortable with. With their patience and openness they created an
enjoyable working environment.
3. 3
Content:
Acknowledgement………………………………………………………………………...… 2
Introduction………………………………………………………………………………..... 5
Organization……………………………………………………………………………...…. 6
Student work………………………………………………………………………………… 7
Department of Health Promotion……………………………………………………………. 8
Joint action mental health well-being…………………………………………………...…... 8
Joint action mental health well-being project in Latvia……………………..…………...… 9
Department of Addiction disease risk analysis………………………………………...…... 12
Online gambling addiction……………………………………………………...………….. 12
Department of Dental care……………………………………………………...………….. 16
Health statistics division…………………………………………………...………………. 15
Data analysis and research department...........................................................................…... 23
4. 4
Health behaviour in school Aged children (HBSC)……………………………………...... 23
Conclusion and Reflection on Internship………………………………………………….. 28
Source……………………………………………………………………………………… 29
5. 5
Introduction:
This report is a short description of my two month internship carried out as compulsory
component of my Masters in Health Management course. The internship was carried out
within the organization of Centre for Disease Prevention and Control of Latvia.
At the beginning of the internship I formulated several learning gaols, which I wanted to
achieve:
- To understand the functioning and working conditions of a health care organization
- To see what is like to work in a professional environment
- To use my gained knowledge and skills
- To see what skills and knowledge I still need to work in a professional environmen
- To learn more about the management side like project management (planning,
preparation, etc)
After my first internship as a trainee in CDPC, where I gained knowledge about the
organization, its function, structure and more in-depth knowledge about health promotion and
addiction department and some notes about data collection and so on,
I was placed once again in CDPC under the subject of “Organisation of public health
studies”, to understand the management point of view.
Disease prevention and control centre of Latvia is the Minister of health under the authority
of a direct regulatory authority.
The centre’s aim is to implement national public health policies epidemiological safety and
disease prevention, sub-domine, as well as to provide health promotion policy and
coordination.
Objective:
The objective of this internship placement is to
gain in-depth knowledge of healthcare organization in person
To learn how to ,acquire,collect,process,analyze and disseminate domestic
and foreign data users with the necessary national statistical information
on ,health risk factors, smoking in youth etc,
6. 6
To learn how disease prevention and health promotion programs are
developed and to know about the implementation of methodological
guidance.
Policy making guideline
Organization
Profile
The center for disease Prevention and control (CDPC) of Latvia was established on 1st April
2012 by cabinet of Ministers of Latvia, Center is supervised by Ministry of Health.
The centers main aim is at strengthening Latvia’s Public Health system, Preventing
Diseases, Including Infectious Diseases.1
Also in implementing national public health policies epidemiological safety and disease
prevention sub-domains, as well as to ensure the health promotion policy and coordination.2
Functions of the centre
Some of the functions of the centre is,
Is to develop based on scientific evidence and international best practices
appropriate proposals for health care and public health policy-making
and to present proposals on the policy priorities,
Carry out non-communicable disease surveillance, as well as to assess
the factors which may affect public health;
Carry out epidemiological surveillance of infectious diseases, monitoring
and intelligence;
Organize communicable disease prevention and control actions,
including measures for population groups at increased risk of infection or
belonging to special risk groups;
Coordinate and supervise the execution of policy planning documents
epidemiological security domain needs;
Acquire ,collect, process and analyze public health and health statistics;
To carry out public health monitoring.
7. 7
Organizational structure:
Figure 1: Selective Organizational structure2
Student Work:
Departments in was posted:
1. Department of Health promotion
2. Department of Addiction disease risk analysis
3. Department of Dental Care
4. Health statistics Division
5. Data analysis and research department
Department of health promotion:
Where I was placed for the first week and got to know about the project,
The project management on CDPC
Literature studies and discussion on it
Director
Deputy director
development and
epidemiological
Infectious diseaserisk
analysis and prevention
department
Infectious disease
surveillanceand
Immunization Divition
Infectious Disease
Prevention andanti-
epidemic measures
Section
Deputy directorpublic
health andprevention
issues
Research andHealth
Department of
Statistics
Health Statistics
Division
Addiction diseaserisk
analysis department
Non-infectious diseàse
data analysis and
Research department
Health Promotion
Department
DiseasePrevention
Division
8. 8
Details on Mental Health and well Being project
About other international project
And I was given more detailed insight on the project Joint Action -Mental Health and Well-
being.
Joint Action Mental Health Well Being:
The joint action for mental health and well-being (JA MH-WB), lunched in 2013,
Aim:
Aims at building a framework for action in mental health policy at the European level and
built on previous work developed under the European Pact for Mental Health and well-
being. Funded by European Agency for Health and Consumers, the joint Action involves 51
partners representing 28 EU Member States and 11 European originations.
Objective:
The objective of the JA MH-WB is to contribute to the promotion of mental health and well-
being, the prevention of mental disorder and the improvement of care and social inclusion of
people with mental disorder in Europe.
The joint Action addresses issues related to five areas:
1. Promotion of mental health at workplaces;
2. Promotion of mental health in schools:
3. Promoting action against depression and suicide and implementation of e-
health approaches;
4. Developing community-based and socially inclusive mental health care for
people with severe mental disordering; and
5. Promoting the integration of mental health in all policies.
Expected Outcome:
The expected outcome of the JA MH-WB include:
A more rigorous and comprehensive knowledge on the situation of mental and well-
being being in EU countries;
Creations of an inventory of existing evidence, good practice and viable resources;
Strengthening of national and European networks;
9. 9
Recommendation for action;
Building capacity of national mental health leaders and other stakeholders in mental
health and well-being in EU countries;
Endorsement of a framework for action by MS and EU agencies well as their
commitment for follow-up action;
Establishment of a structural cooperation between the Joint Action and networks
from others European projects;
Creation of mechanisms supporting a structured collaboration between key actors in
the implementation of mental health policies in Europe.
In each of the five areas of work of the Joint Action, a similar methodology was adopted,
which includes a situation analysis in participating country, the development of
recommendations for action ,and the support to the endorsement of a framework for action
by EU and member states.3
JA MH-WB project in Latvia:
In Latvia, the project JA MH-WB was implemented from Feb 2013 till January 2016.
And the work package was “Taking Evidence-based Action against Depression, Including
actions of preventive suicide. E-health”.
Project Activity:
The overall objective of the project is to promote mental health and well-being promotion,
mental disorder prevention and care, and improving the social inclusion of persons with
mental disorder in Europe.
4 work packages “Evidence-based action against depression, including action to prevent
suicides. E-health “is leaving the knowledge base of the commercialization and
implementation process for existing activities related to depression and suicide prevention
nature package in the countries concerned, including a variety of e-solutions for the
environment.
Task:
Identify key stakeholders in the work package in the countries concerned;
10. 10
Carry out the situation analysis of the scientific evidence, best practices and available
resources for implementation of activities of depression and suicide prevention work package
in the countries concerned;
Develop recommendations for evidence-based action of depression and suicide prevention at
international and national level.
Result:
The result of this two year project they have achieved in identified key project stakeholders at
the national level (which is confidential) 4.
Latvia stands 3rd among the European countries for depression and suicide rate. Where it is
said 382 people a year which is every day a person is attempting suicide and the reason vary,
Some of the common key facts regarding mental stress and depression, which can be also
related with Latvia.
Almost 9 out of 10 of people suffering from mental health problems say they have
been affected by stigma and discrimination, and more than 7 out of 10 report that
stigma and discrimination stopped them from doing things.
The annual suicide rate is 13.9 per 100 000 on average in the European region, but
varies widely between countries. The countries with the highest suicide rates in the
world are in European Region.
In several countries, suicide is the number–one cause of death in adolescents.
In Europe, men are almost five times more likely to commit suicide than women.
An estimated 20% of people who commit suicide had been in contact with their
general practitioners (GPs) or psychiatric services within one week of their deaths,
and 40% in the preceding month.
The ageing of the population is resulting in increasing prevalence of dementia,
typically 5% in people over 65 and 20% of those over 80.
Unemployment, debt and social inequality are all risk factors for depression and
associated with suicide.
Mental health is strongly related to the socioeconomic circumstances of people’s
lives. Factors such as poverty, unemployment, poor working conditions, substandard
housing and poor education reduce well-being, as well as significantly increasing the
11. 11
risk of mental disorders5.
Figure 2: Suicide rate in EU countries6
Result:
Though Latvia has taken much initiative actions of depression and suicide issues in the past
years, they can try to implement some other member states specific project which have been
achieved and have given good result.
For example implementing the European Pack for Mental Health and well-being, which is a
statement of commitment from European Member States to a long-term process of
exchange, cooperation and coordination on key challenges relating to mental health, and
provides an EU-framework enabling exchange and cooperation between stakeholders in
different sectors including health, employment and education on the challenges and
opportunities in promoting better mental health7.
13.7
17.4
14.7
11.3
15.6
10.5
4.2
22
6.3
19.1
29.1
9.4
5
1010.2
15.7
9
6.9
11.612
7
5.8
11
16.6
6.4
1.12.1
20.4
29.5
AUT
BEL
CZE
DNK
FIN
DEU
GRC
HUN
ITA
JPN
KOR
LUX
MEX
NLD
NOR
POL
PRT
ESP
SWE
CHE
GBR
BRA
CHL
EST
ISR
ZAF
TUR
LVA
LTU
Suicide Rate
12. 12
Department of Addiction disease risk analysis:
Second week I was placed in Addiction disease risk department where I was given a task of
doing a search on ‘Online Addiction on gambling’ and preparing a questioner for a survey
project which is yet to be started. As this was once again related with mental health.
Some insight about online gambling addiction or problem gambling related with mental
health:
Online gambling addiction:
Definition:
Online gambling is a fast developing activity in Europe, both in terms of supply and
demand.
“A progressive disorder characterized by a continuous or periodic loss of control over
gambling; a preoccupation with gambling and with obtaining money with which to gamble;
irrational thinking ;and a continuation of the behaviour despite adverse consequences” 8.
The national council on Gambling defines problem gambling as,” Gambling behaviour
which causes disruptions in any major area of life: psychological, physical, social or
vocational”. This may include pathological and compulsive gambling, which is a form of
addiction that grows worse as time progresses9.
Gambling problem rates in Europe:
Problem gambling rates in Europe appears to be similar to rates found elsewhere
(typically 0.5%-2%), although a few countries (e.g., Estonia, Finland, Switzerland)
have reported problem gambling prevalence rates of above 3%.
Relatively few studies in Europe report prevalence rates for probable pathological
gambling .However, results from these studies suggest broadly similar rates.
Prevalence studies in Europe have tended to report that problem gamblers are most
likely to be electronic gaming machine (EGM) players including Estonia, Germany,
Holland, Norway, Sweden and Switzerland.
Other studies have also found similar results with adolescents reporting that the min
type of problem gambling among adolescents is related to EGM ply (e.g., Great
13. 13
Britain, Iceland and Lithuania).
Many European countries report that problem EGM gamblers are most likely to seek
treatment and /or contact national gambling helplines including: Belgium 60%,
Denmark 72%, Estonia 93%, Finland 66%, France 50%, Germany 83%, Great
Britain 45%, Spin 75%, and Sweden 35%10.
Teens are Most at Risk:
Teens who suffer from poor family relationships are most at risk. The accessibility of online
casinos, sports betting sites, and online poker make it all too easy for teens to gamble.
Unpleasant feelings such as stress, depression, loneliness, fear, and anxiety can trigger
compulsive gambling or make it worse. Adults suffer too. After a stressful day at work, after
an argument with your spouse or co-worker, or to avoid more time spent on your own, an
evening at a virtual casino can seem like a fun, exciting way to unwind and socialize.
Effects of Problem Gambling:
There are an array of harmful effects rising from problem gambling including:
NCPG (National Council of Problem Gambling) says that approximately 76 percent
of problem gamblers are likely to have a major depressive disorder.
NCPG also says children of problem gamblers are at higher risk for a number of
behaviors including problem gambling, tobacco use, and drug use.
An Australian study found that one in five suicidal patients had a gambling
problem11.
Task:
Questionnaire on online gambling:
Online Gambling:
(This questionnaire was composed of yes or no question that tested components of addiction
such as preoccupation, tolerance, loss of control, withdrawal, salience, conflict, escape,
relapse, and mood modification. Each yes answer was considered a point, and a combined
total of 5 or more points indicated online gambling addiction on a range of 0-8. Thus, an
online game addicted group, a social player group (1-3 points), and a non-addicted group
were created from this portion.)
1. Do you feel preoccupied with the Internet (think about previous online activity or
anticipate next online sessions)?
14. 14
2. Do you feel preoccupied with gambling (think about previous gambling activity or
anticipate next gambling sessions)?
Emotional disturbances:
3. When you are near your device do you feel more comfortable and secure, and when
you are away from your device do you feel less comfortable and secure?.
(Participants answered on a Likert scale, with 1 being true, 3 being doesn't matter, and 5
being false)
4. How would you rate your day?
5. How many hours did you spend playing online gambling?
(The former question was answered using a Likert scale, with 1 being absolutely terrible and
10 being a really great day. The latter was answered with a positive number between 0-24)
Computer Usage:
6. How many hours of the day they played today?
7. What type of gambling game? - this was to determine if a specific type of game was
more addictive or salient to play than another one
8. What type of device was used to play online gambling? - This was to determine if
online gambling are limited to simply computers, or if participants play on these other
devices , such as on iPod or phones
9. what major online gambling games they have played in the past 3 months?- This is
similar to the question, what type of game they enjoy, and can check consistency; it
can also show if there is a game that is more addictive or popular than others
10. Other activities while playing online gambling, with a follow up of what kinds of
activities?- This will determine if they are engaged by the online gambling, or are
capable of multitasking and being productive
Withdrawal:
11. Do you feel restless, moody, depressed, or irritable when attempting to cut down or
stop online gambling?
15. 15
12. When refraining/controlling your online gambling game usage, have you ever felt any
of the following?- This is a checklist based off of the DSM-IV’s criteria for addiction,
and it includes: anxiety, restlessness, irritability, insomnia, headaches, poor
concentration, depression, social isolation, sweating, racing heart, palpitations, muscle
tension, tightness in the chest, difficulty breathing, tremor, nausea, vomiting, or
diarrhea, and non-applicable12.
Internet Gambling Addiction Test:
Answer “yes” or “no” to the following statements:
1. Do you need to game with increasing amounts of money in order to achieve the desired
excitement?
2. Are you preoccupied with gambling (thinking about the next bet, anticipating your next
online session)?
3. Have you lied to friends and family members to conceal extent of your online gambling?
4. Do you feel restless or irritable when attempting to cut down or stop online gambling?
5. Have you made repeated unsuccessful efforts to control, cut back, or stop online gambling?
6. Do you use gambling as a way of escaping from problems or relieve feelings of helplessness,
guilt, anxiety, or depression?
7. Have you jeopardized or lost a significant relationship, job, or educational or career
opportunity because of online gambling?
8. Have you committed illegal acts such as forgery, fraud, theft, or embezzlement to finance
online activities?
(If you answered “yes” to any of the above questions, you may be a compulsive online
gambler. These are signs that you have lost control, lied, or possibly stole money just to
support your trading behaviour.)13
What are the warning signs of pathological gambling?
Gamblers' Anonymous asks its new members twenty questions:
Did you ever lose time from work due to gambling?
Has gambling ever made your home life unhappy?
16. 16
Did gambling affect your reputation?
Have you ever felt remorse after gambling?
Did you ever gamble to get money in which to pay debts or otherwise solve financial
difficulties?
Did gambling cause a decrease in your ambition or efficiency?
After losing, did you feel you must return as soon as possible to win back your losses?
After a win, did you have a strong urge to return and win more?
Did you often gamble until your last dollar was gone?
Did you ever borrow to finance your gambling?
Have you ever sold anything to finance your gambling?
Were you reluctant to use "gambling money" for normal expenditures?
Did gambling make you careless of the welfare of yourself and your family?
Did you ever gamble longer than you planned?
Have you ever gambled to escape worry our trouble?
Have you ever committed or considered committing an illegal act to finance
gambling?
Did gambling cause you to have difficulty in sleeping?
Do arguments, disappointments, or frustrations create within you an urge to gamble?
Did you ever have an urge to celebrate any good fortune by a few hours of gambling?
Have you ever considered self-destruction as a result of your gambling?14
Result:
Unfortunately there is no data available on online gambling addiction in Latvia.
Department of Dental Care:
Every Wednesdays I was posted in Dental Department, to get an idea about the,
project on “Oral Health survey in School Children in Latvia”
Mobile Dental Care
About periodontal epidemiology special interest group
17. 17
Also gained knowledge about continuous professional development and
lifelong learning for health professionals in the EU
Surveys conducted among GPs, Dentist, Midwives, and nurses and
pharmacists.
Health statistics Division:
Forth department where I was posted is health statistics division,
Gained knowledge about health statistics sites
Literature studies and discussion on it
Health at a glance
Euro-Peristat
Also bout the development of guidelines for statistics on cause of death registration
And was given task to do presentation on Health at a glance,
Task:
Health at a glance:
Indictors:
Health status
Risk factors for health
Health workforce
Access to care
Quality of care
Health expenditure and financing
Health Status:
Smoking
Alcohol
Mental depression
Suicide
23. 23
Health Expenditure :
Expenditure
Financing
Figure 13
Data analysis and research department:
Where I was posted last and here I was introduced to the project called HBSC, and had
discussion about the protocol of this project (Confidential document).
Health behaviour in school Aged children (HBSC): Cross-national survey of school
students
The HBSC research network is an international alliance of researchers that collaborate on
the cross-national survey of school students: Health Behaviour in School-aged children. The
HBSC collects data every four years on 11-, 13- and 15-yer-old boys and girl’s health and
well-being, social environments and health behaviours. These years mark a period of
increased autonomy that can influence how their health and health-related behaviours
develop. HBSC now includes 44 countries and regions cross Europe and North America.
24. 24
Purpose of this survey:
Behaviours established during adolescence can continue into adulthood, affecting issues
such as mental health, the development of health complaints, tobacco use, diet, physical
activity levels, and alcohol use. HBSC focuses on understanding young people’s health in
their social context-where they live, at school, with family and friends. Researchers in the
HBSC network are interested in understanding how these factors, individually and together,
influence young people’s health as they move from childhood into young adulthood. The
international network is organised around an interlinked series of focus and topic groups
related to the following areas:
Body image
Bullying and fighting
Eating behaviors
Health complains
Injuries
Life satisfaction
Obesity
Oral health
Physical activity and sedentary behavior
Relationships: Family and Peers
School environment
Self-rated health
Sexual behavior
Socioeconomic environment
Substance use: Alcohol, Tobacco and Cannabis
Weight reduction behavior
Use of the survey data:
HBSC’s findings show how young people’s health changes as they move from childhood,
through adolescence into adulthood. Member countries and stakeholders at national and
international levels use our data to monitor young people’s health, understand the social
determinants of health, and determine effective health improvement interventions. Those
working in child and adolescent health view HBSC as an extensive databank and repository
25. 25
of multidisciplinary expertise, which can: support and further their research interests, lobby
for change, inform policy and practice, and monitor trends over time15.
I was mainly exposed to the issue and the promotional activity for Bullying and fighting
mong school children.
Bullying is defined as the use of power and aggression to cause distress or control another.
The use of power and aggression may be carried out through direct and indirect forms of
aggression. Direct bullying can include physical aggression (hitting, kicking) and verbal
aggression (insults, racial or sexual harassment, threats).Indirect bullying is the manipulation
of social relationship to hurt (gossiping, spreading rumours).
Countries throughout the world have identified bullying as a leading adolescent health
concern several studies have examined correlates of bullying, including its association with
mental and physical health problems, academic problems, and delinquency and crime.
Below in Figure 14 & 15 represents a geographic patterns in bullying and associated
victimization (40 countries)
Involvement of boys in all 3 categories of bullying combined –
Bullying others,
Being bullied
Being both a bully and a victim
Figure 14 explains among boys 8.6% in Sweden and 45.2% in Lithuania which is 5 fold
difference across countries with an overall median of 23.4%.Figure 15 explains among girls
it is 4.8% in Sweden to 35.8% in Lithuania ,a 7 fold difference across countries with an
median of 15.8%.
Latvia stands 2nd in the top 10 countries by rank out of 40 countries16
27. 27
Figure 15
Result:
The CDCP have taken efforts to reduce the bullying and have also done some promotional
activity by developing and promoting two educational films for school students and
teachers.
This educational film which indirectly addresses the teachers and parents, encouraging
recognize bullying, pay close attention to it and to actively engage in mockery situations17
28. 28
Conclusion and Reflection on the Internship:
On the whole, this internship was a useful experience. I have gained new knowledge, skills
and met many new people. I achieved several of my learning gaols.
I got insight into professional practice. I learned the different facets of working within a
Organization. Related to my study I learned more about the organization management,
project management, data collection etc.
Unfortunately the time wasn’t enough to fully contribute myself in any of the project ,but
they gave me chances to gain knowledge about their projects and to express my ideas and
my opinions on their project which gave me more confidence .
In advance of my internship, I have discussed with the origination for some help for my final
theses, which I’m planning to do on one of the topic and department which I was placed, and
also on which I got impressed. Sill that’s in later part.
At the last this internship has given me new insights and motivation to pursue my final
theses as well as for my future career.
