Slovenian Journal of Public Health

DEVELOPMENT OF ACADEMIC EDUCATION OF NUTRITIONISTS IN THE REPUBLIC OF MACEDONIA

Vera P. Simovska-Jarevska, MD., PhD Vesna Antoska-Knights, PhD Tatjana Kalevska, PhD Tatjana Blazevska, MSc University St. Clement Ohridski of Bitola, Faculty of Technology and Technical Sciences-Veles Republic of Macedonia

Corresponding Author: Ass. Prof. Simovska-Jarevska P. Vera, MD., PhD University St. Clement Ohridski of Bitola Faculty of Technology and Technical Sciences-Veles Str. Dimitar Vlahov bb, 1400 Veles Telephone number: +389 (43) 221 202 Fax number: +389 (43) 221 204 Republic of Macedonia Email: v.simovska@gmail.com http://www.ttfv.uklo.edu.mk

Co-author email adresses: vesna.antoska@uklo.edu.mk tatjana.kalevska@uklo.edu.mk tatjana.blazevska@uklo.edu.mk

Abstract: Objectives, Introduction, Methods, Discussions and Conclusion.

Objectives: Supporting proactive partnership in defining national standards for the formulation of academic study programs in food and nutrition sciences, supporting introduction of innovative food technologies, nutrition and dietetics, forming a set of competencies upon completion of studies and creating and rolling out website and elearning tools.

Introduction: Social and national needs of the country are to educate and produce highly trained scientific staff, specialized in nutrition at Bachelor, Master and Doctoral degree levels including: 1st cycle qualification in engineer technologist-nutritionists, 2nd cycle qualification in nutrition, food quality and safety and 3th cycle qualification in innovative food technologies and nutrition.

Methods: The model of designing, planning and implementation of curriculums is in accordance with European standards for improvement of academic and practical curricula and EFAD/DIETS2 advanced competencies for nutritionists/dietitians. Proactive work with the industry is related to internships placements. Innovative application of ICT, e-learning and creating a website are intended for collaboration with other national and European nutrition networks.

Discussions: In order to improve population health, by improving the quality of nutrition and nutrition practices through education and research, we development and implementation of the new academic programs for food, nutrition and dietetics, and innovative technologies in higher education in the Republic of Macedonia in accordance with European standards of EFAD/DIETS2.

Conclusion: With more than 350 students enrolled, the Bachelor’s academic study program has shown to be successful, increasingly popular and commanding rising interest among the youth. Both the academic staff and the students of nutrition have taken part in various activities including the Tempus collaborative research project of the European Commission entitled “Foodlinks”, focused on the link between the academia and the food industry and two domestic projects.

Keywords Nutrition, Academic education, Research, Descriptors, Competencies, e-learning, Higher academic institution.

1. Introduction Numerous nutrition and food technology education programs started being implemented in higher education institutions across the United States, Europe and the Balkans. Higher education institutions in Slovenia and Croatia currently focus particularly on introducing Food Technology in the academic studies of nutrition, in order to increase availability of nutrition professionals in reformulation of food products and support and facilitatate iimprovements of the existing food technologies.

Unhealthy nutrition practices are one of the key risk factors for developing main noncommunicable diseases in the Republic of Macedonia. Studies have confirmed that the

country's population has unhealthy eating habits. Also, in the country, there is no nutrition and dietetics curriculum for higher education institutions.

Analyzing the results of numerous

scientific findings that confirm the important role of food and nutrition in health promotion and prevention of nutrition-related diseases, we developed the academic study programs for food science, innovative food technologies, and human nutrition and dietetics.

The Republic of Macedonia experienced a turning point for the nutritionist profession in 2009 when the Steering Committee for Advancement of Healthcare system was launched at the Macedonian Ministry of Health. After numerous discussions about the deficit of professional staff in the country, the experts of the Steering Committee emphasized the need for an academic study for the food, nutrition and dietetics. For the first time tangible results were seen and laws and regulations have been produced to advance the subject. The most substantial product of the work of the Committee is the “Green Book” which integrated all necessary national healthcare reforms [1]. At the same time, the University of Bitola “St. Clement of Ohrid” started developing a new academic curriculum in the field of nutrition. The multidisciplinary nature of nutrition is reflected in the academic study programs, which includes experts of nutrition and sports medicine, biochemists, biostatisticians, tecnologists, and engineers. In 2010, the University introduced the Bachelor’s Degree program which currently enrolls more than 350 undergraduate students. The Program for Nutritionists at the Faculty of Technology and Technical Sciences Veles is offered in three different towns across the country: Veles, Bitola and Kicevo. The Master’s and Doctoral degrees including 2 nd cycle qualification in nutrition, food quality and safety, and 3 th cycle qualification in food technologies and nutrition are designed to train professionals to identify, understand and solve, through scientific methods, problems of nutrition and dietetics, and innovative food technologies.

Graduates are expected to assume leadership roles in academia, government, industry or other private-sector enterprises. They will be expected to advance knowledge in human nutrition through research, and advocate the application of such knowledge through public health policies and programs.

2. Academic curriculum in the field of nutrition

2.1. The curriculum

The need to introduce a Bachelor’s, Master’s and Doctoral degrees (1 st, 2nd and 3th Bologna cycle qualifications) of multidisciplinary studies in Nutrition in the Republic of Macedonia is a result of numerous scientific findings that confirm the lack of knowledge for the important role of food, innovative food technology and proper nutrition on national level. In addition, one of the main goals for creating the program was the need to have own staff in the country that will work in the domain of food science and facilitate production and processing, so existing issues can be addressed, and new ones will be prevented from arising. In summary, it is foreseen that the new nutrition professionals will assist in education, health maintenance, prevention and treatment of diseases on individual and national level.

A major in Nutrition within University of Bitola “St. Clement of Ohrid” is established within two focus areas of work: one is Nutrition and Dietetics, and the other Food Technology and Biotechnology. With the development and implementation of the program in 2010, a new multidisciplinary educated academic profile was introduced, entitled “Engineers of Technology - Nutritionists”. The new title was recognized and acknowledged by the European Federation of the Associations of Dietitians (EFAD).

The process of designing and implementing the National Framework for Higher Education Qualifications in the Republic of Macedonia is in consonance with the overarching Framework for Qualifications of the European Higher Education Area [2] and the Official Gazette of the Republic of Macedonia, 2010 [3].

The first two Bologna cycles have been associated with the following European Credit Transfer System (ECTS) credit ranges: - Bachelor’s degree, or 1 st cycle qualifications that typically include 240 ECTS credits equivalent to level 6 of European Qualifications Framework (EQF).

- Master’s degree, 2nd cycle qualifications that typically include 60 and 120 ECTS credits equivalent to level 7 of EQF and - Doctoral degree, 3th cycle qualifications that include 180 ECTS credits equivalent to level 8 of EQF. The academic curriculum and structures of the practice placements of both Bachelor’s and Master’s programs is based on the framework for ECTS calibration [2, 4] and the following statements of the European Federation of the Associations of Dietitians (EFAD): the European

Dietetic

Benchmark Statement (EDBS) [5]

and

the

European

Dietetic

Competencies and their Performance Indicators (PIs) [6]. The Master’s and Doctoral Degree Programs are based on the model of the European Commission/EACEA: Thematic Network

for Dietetics - DIETS2 (2010-2013) [7]. The Work Package 2 (WP2) of DIETS2 developed advanced level benchmark competence statements for European dietitians entitled European Dietetic Advanced Competences (EDAC) [7].

The model of design, planning and implementation of the curricula in the 1 st, 2nd and 3th cycle qualifications is based on the methodology proposed in the Dublin description of program design (2004) and the EU Educational Structures project “Tuning” (2009). In 2011, Public Health National Organization for the promotion of health entitled “HEPA Macedonia” became an associate member of the European Thematic Network for Dietetics and a team member of the DIETS2/WP2 “Second and third cycle competences for dietitians”. The membership and recognition acquired has contributed to a great degree in the development of the profession of nutrition and dietetics within the Republic of Macedonia [8].

2.2. THE THERORETICAL PART OF THE STUDY PROGRAM Study program is divided into the four sub-groups: 2.2.1. Basic Sciences: biology, physics, chemistry, nutritional biochemistry (cell and molecular basis of disease and metabolic complications), anatomy, nutritional anthropometry, physiology, histology, genetics, immunology, biostatistics and mathematics, computers, and methods of scientific research.

2.2.2. Food Science and Innovative Food Technology: a) Food Science and Innovative Food Technology: nutritional values of common foods, the innovative technology for food, reformulation of food production, food processing, modeling and optimization in food technology, biotechnology and robotics in food industry. b) Science of Nutrition and Dietetics: nutrition care model and process, methodology of nutritional assessments, examination of dietary intake, nutritional testing, modification of diet in people with different dietary habits, modeling and optimization in nutrition, cultural and socio-economic conditions, hygiene of nutrition for healthy and sick people, medical terminology and classification of diseases, international dietetics and nutrition terminology (IDNT), medical nutrition therapy (MNT), nutrition care process, common types of diet therapy and diagnostic procedures, modeling and optimizing in nutrition, techniques of food

preparation, sensory evaluation, microbiology, food safety and hygiene of food, practice based on data and evaluation of practice.

2.2.3. Administration of Food Services: management, planning and production of food legislations, economics, marketing, food equipment, packaging and distribution.

2.2.4. Public Health Nutrition: nutrition and physical activity, health promotion, nutritional epidemiology, planning, coordination and evaluation of public health strategies and policies, sociology, ethics, communications and cultural aspects of nutrition.

Further, to improve population health, by improving the quality of nutrition education and research at advanced level we determined the following objectives: - Supporting proactive partnership in defining national standards for the formulation of Doctoral study program for the innovative technologies for food and nutrition; - Forming a set of competencies upon completion of studies; - Application of information and communication technology (ICT) and e-learning.

Proactive work with the industry and private companies is related to practice placement and internships. An Innovative application of ICT, e-learning and creating a website are intended for collaboration with other national and European nutrition networks.

Robotics in food technology as a subject with basic concepts of definitions, classifications, historical development, application and examples of robots in the food industry is implemented.

In addition, the Master and Doctoral programs are especially focused on the scientific and research aspects to enable the students developing and conducting various types of research applying diversified methodology. Modelling and optimization in nutrition is very important in planning meals for groups and individuals. Data base of nutritional composition of foods with mathematical and numerical methods covers the central concepts of practical optimization techniques: fundamentals of linear optimization and simplex method, viewing software for optimization, programming and analysis, basics of fuzzy optimization.

Study programs will bring about education and creation of our own nutritionists who will be able to meet the domestic and global issues relating to food and nutrition, inclusion of the researchers and experts in the projects and in the healthcare teams, university and research institutions and the food industry. They will be qualified to execute tasks liked to production of healthy, quality, safe, environmentally friendly and affordable food for domestic and export needs. Also, these nutritional experts will contribute to changes in public health policy and health education strategy (2014 - 2020) in the area of “Health Enhancing through Nutrition Education�.

2.3. Implementation and results With more than 350 students enrolled, the Bachelor’s academic study program has shown to be successful, increasingly popular and commanding rising interest among the youth. The study program lasts 8 semesters or 4 years, each semester totaling 60 ECTS credits. The lessons are conveyed by an academic staff possessing multidisciplinary educated profiles ranging in the areas: nutritional medicine and dietetics, food technology and biotechnology and natural and computer sciences. Both the academic staff and the students of nutrition have taken part in various activities including the Tempus collaborative research project of the European Commission entitled “Foodlinks”, focused on the link between the academia and the food industry. Another domestic project financed by the University Research Centre “St. Clement Ohridski” of Bitola that joined academic staff and students was “Monitoring of Eating Habits and Physical Activity Behavior among the Macedonian Population”.

That project was implemented countrywide during 2011 and2012.

Some of the many project outcomes were scientific articles published in the international journals [9, 10, 11]. The students were actively involved in the initial process of conducting the survey for the research. Also, with 60 graduate students enrolled, the Master study has shown rising interest among graduated engineers of technology-nutritionists.

3. Conclusions

- The first national “cross-sectional” study in the Republic of Macedonia with title: “Monitoring of Eating Habits and Physical Activity Behavior among the Macedonian Population” conducted by the Faculty staff (2011/2012) with an aim to analyse and evaluate data on socioeconomic differences in educational levels and income on the consumption of the main health related foods and physical activity levels of the population (10–64 years) is essential for planning and evaluation of the NCDs prevention program. The research provides results for health-policy decision-making and can be used to evaluate specific health promotion and NCDs prevention programs [9, 10].

- In line with the strategic development plan of the University St. Clement Ohridski of Bitola, the next step for the program will be further improvement and development of the role of nutritionists with Bachelor’s, Master’s and Doctoral degrees (1 st, 2nd and 3th Bologna cycle qualifications of multidisciplinary nutrition studies) in the healthcare strategy and in the prevention of NCD’s [12], but also in the domain of food production, food technology and biotechnology.

- With the improved number of nutritionists in the country, an opportunity arises for development of a National Association for Nutritionists in the Republic of Macedonia [13].

4. A list of abbreviations:

NCD’s – Noncommunicable diseases UN – United Nations WHO – World Health Organization FAO – Food and Agriculture Organization EFAD - European Federation of the Associations of Dietitians ECTS - European Credit Transfer System EQF - European Qualifications Framework EDBS - European Dietetic Benchmark Statement PIs - European Dietetic Competencies and their Performance Indicators EC - European Commission EACEA - Education, Audiovisual and Culture Executive Agency DIETS2 - Thematic Network for Dietetics WP - Work Package EDAC - European Dietetic Advanced Competences EU – European Union MNT - Medical Nutrition Therapy IDNT - International Dietetics and Nutrition Terminology ICT - Information and Communication Technology HEIs – Higher Education Institutions Competing Interests

The authors declare that they have no competing interests.

Authors’ Contributions

VSJ participated in the model of designing, planning and implementation, and coordination of curriculums related to science of Nutrition and Dietetics, Medical Nutrition Therapy as well as Public Health Nutrition creating the first national “cross-sectional” study in the Republic of Macedonia entitled “Monitoring of Eating Habits and Physical Activity Behavior among the Macedonian Population”. As an expert in the European Commission, she was contributed in the implementation of

the Bologna Declaration (1999), Dublin description (2004), EC

"Tuning" project (2009), European standards for improvement of academic and practical curricula (2010) and EFAD/DIETS2 advanced competencies (2013) in the higher education institution. She carried out the human nutrition and dietetic practice placements in the country

participating as a team member of the project of the European Commission: EACEA/DIETS2WP2 “Second and third cycle competences for dietitians”. Also, she was participant in the research project of the European Commission entitled: “FOODLINKS” - Improving AcademiaIndustry links in food safety and quality. She drafted the manuscript.

VAK contributed by innovative application of ICT, e-learning and creating a website intended for collaboration with other national and European nutrition networks, in these doctoral studies. Also as a contribution was implementing new modern subjects as a Modelling and optimisation in nutrition and food technology and Robotics in food technology. She is participant in “FOODLINKS” - the international research project of the European Commission for part of implementing e-learning and participant in EC/FP7 project: “Embodied Cognition in a Compliantly Engineered Robot”.

TK contributed in creating a section of the multidisciplinary Doctoral study program with title: “Food and innovative technologies” focused on the process-technology function of food production in accordance with the demands of the contemporary technique, technology and science of food, which will enable education of doctors of science (PhD), trained for independently leading original and scientifically relevant researches, capable of analysis of foodstuff-technological

processes,

development

and

implementation

of

innovative

technologies in foodstuff processing engineering and use of methodologies for obtaining minimally processed food with optimal nutritive values and functional bioactive characteristics.

Also, she was participant in the research project of the European Commission: “FOODLINKS” - Improving Academia-Industry links in food safety and quality. Working with the local industry, she participated in the regional project: “Implementation and audit of quality systems ISO 9001 and ISO 22000”.

TB carried out the molecular genetic studies. She participated in design of the study programs focused on basic sciences, applied microbiology and helped to draft the manuscript.

All academic staff of the Faculty of Technology and Technical Sciences–Veles contributed towards implementation of the national “cross-sectional” study by making substantial contributions to acquisition of data, and analysis and interpretation of data. Also, they

contributed towards the Doctoral degree programs by making substantial contributions to conception and design. SM, DD and DNN were involved in drafting the manuscript, but they does not meet the criteria for authorship.

All authors read and approved the final manuscript.

The source of funding All authors contributed towards the academic study design, planning and implementation without finacial support working as volunteers.

5. References

[1] Simovska V. at all. Good Governance. In: Osmani B., (Ed.), Green Book, Steering Committee for the Advancement of Healthcare System, Ministry of Health, Republic of Macedonia. 2010. pp. 3-50.

DOI:10.13140/2.1.4652.1126. Accessed

March 3, 2015.

[2] Bologna Working Group on Qualifications Frameworks. A framework for Qualification of the European Higher Education Area. Ministry of Science, Technology and Innovation, Copenhagen, Denmark, 2005. <URL:http://www.ond.vlaanderen.be/hogeronderwijs/bologna/documents/050218_QF_EHEA. pdf. Accessed September 5, 2010.

[3] Republic of Macedonia Government. Regulation on National framework for Qualification of the Higher Education Qualifications (in Macedonian). Official Gazette of the Republic of Macedonia 2010 (154), pp. 16-18.

[4] Towards the European Higher Education Area - Bologna Process. The official Bologna Process website 2007-2010. <URL:http://www.ond.vlaanderen.be/hogeronderwijs/bologna/about/. Accessed 5 July 2010.

[5] The European Federation of the Associations of Dietitians. European Academic and Practitioner

Standards

for

Dietetics

(EDBS),

Brussels,

Belgium

2005.

<URL:http://www.efad.org/everyone/2375/5/0/32. Accessed June 2005.

[6] The European Federation of the Associations of Dietitians. European Dietetic Competences and their Performance Indicators (PIs); first cycle. Brussels, Belgium 2009. <URL: http://www.efad.org/everyone/1468/5/0/32. Accessed March 2009.

[7] European Commission/EACEA. European Dietetic Advanced Competences (EDAC).

Thematic Network for Dietetics – DIETS2, Brussels, Belgium 2012. <URL:

http://www.aedn.es/resources/cbc3c2d86c8e83bEDAC_May_2012.pdf.

Accessed

October 2012.

[8] Faculty of Technology and Technical Sciences in Veles. Master’s degree in nutrition (in Macedonian). University St. Kliment Ohridski, Bitola, 2012. <URL:http://www.ttfv.uklo.edu.mk/index.php/studiski-programi/2013-11-03-11-07-30/2013-1103-11-08-53 . Accessed 22 September 2012. .

[9] Simovska-Jarevska V., Martinovski S., Damjanovski D., Pavlova V., Nikolovska-Nedelkova D., Manceski Gj. Monitoring of eating habits and physical activity levels as a basis for a new noncommunicable disease prevention programme in the Republic of Macedonia. Proceedings of the Latvian Academy of Sciences, Section B. Natural, Exact, and Applied Sciences, 2013;67(4-5):357-362. DOI:10.2478/prolas-2013-0072. Accessed December 2013.

[10] Simovska-Jarevska V., Damjanovski D., Pavloska V., Martinovski S., Vidin M.: EVALUATION OF DIETARY HABITS AND PHYSICAL ACTIVITY LEVELS MONITORING AS BASIS FOR A NEW HEALTH PROMOTION STRATEGY IN REPUBLIC OF MACEDONIA. Original Research Article. Procedia - Social and Behavioral Sciences [serial online] 2012; 44:370-374. http://dx.doi.org/10.1016/j.sbspro.2012.05.041 Accessed 2012, June 19.

[11] Simovska V. , Damjanovski D., Pavlova V., Martinovski S., Nikolovska-Nedelkoska D., Antoska V., Mancevski Gj., Vidin M.: THE EFFECT OF SOCIOECONOMIC INDICATORS ON DIETARY HABITS, PHYSICAL ACTIVITY LEVELS (PALs) AND BMI kg/m2 IN MACEDONIAN YOUTH. Vth Congress of Sports Medicine and Sports Sciences of Serbia with International participations, Belgrade, 6-7 December, 2012. Book of Abstract and Original Papers, Belgrade, Serbia 2012:19-21.

[12] Simovska V., Vidin M. Public health and lifestyle interventions to reduce cardiovascular risk in Macedonia: recommendations and evaluation. “Circulation”, Journal of the American Heart Association, Abstracts From the World Congress of Cardiology Scientific Sessions 2012;125:e812-e813. doi:10.1161/CIR.0b013e31824fcdb3. <URL:http://circ.ahajournals.org/content/125/19/e741.full.pdf+html Accessed 2012, April 15.

[13] Simovska-Jarevska VP (2015) Improving Public Health through Nutrition Education. J Nutr Disorders Ther 2015; 5(1):e120. doi:10.4172/2161- 0509.1000e120.