The aim of this study is to estimate the contributions of changes in population distribution by marital status to the changes in adult mortality in six developed countries. The change in total mortality was decomposed into the contributions of: (i) mortality changes within each marital status category; and (ii) changes in population composition by marital status. The study provides evidence that changes in population composition contributed to increases in male mortality in Russia and Lithuania, whereas in the remaining male populations this was a significant obstacle for faster health improvements. The compositional changes had only small impacts on female mortality.
Background: The Russian human immunodeficiency virus (HIV) epidemic among people who inject drugs (PWID) originated in Kaliningrad, but research into risk behaviours among PWID has been lacking. The potential for heterosexual spread has not been analysed. Methods: A sample of PWID was accrued using two methods. A questionnaire was administered to assess HIV-related risk behaviours for parenteral and sexual transmission, sociodemographic factors, HIV knowledge and attitudes about sexual risks. Data were analysed focusing on the role of imprisonment, factors associated with awareness of being HIV infected and condom use. Results: More than a quarter of the sample reported having been diagnosed with HIV infection, with higher prevalence among women and those with a history of incarceration. More than half reported having been diagnosed with hepatitis C virus infection. Those reporting being HIV positive were less likely to distribute used syringes to other PWID and more likely to have used a condom the last time they had sex. A history of incarceration was associated with higher rates of receptive syringe sharing among those not having ever received an HIV-positive diagnosis and a lower likelihood of believing that condoms are needed when having sex with a casual partner. Conclusion: Although extensive HIV testing has alerted many PWID to their HIV-positive status, which is associated with less distributive syringe sharing and higher likelihood of condom use, substantial risk for parenteral and especially sexual HIV transmission remains. More active prevention programs will be required to control the heterosexual spread of HIV.
On the web page of British medical Journal, the outpost of evidence based medicine (EBM) the voting collected 500 voices and 52% agreed that “EBM is broken” (as of June 22). Readers did vote in relation to the article, published by a group of EBM promoters 1. In this article, Trisha Greenhalgh et al. listed for the “Evidence Based Medicine Renaissance Group” number of problems with the development of the EBM practice. Despite successfully addressing these problems, the article call for the “Return to real evidence based medicine”. The call is addressed mostly to clinicians, but three points make it relevant for public health.
In June 2016 the European Commission presented criteria to identify endocrine disruptors in the field of plant protection products and biocides(1). The documents approved are instruments for the move to the practice from the WHO general approach with its definition “Endocrine disruptors are substances, both natural and chemical, that can alter the functions of the hormonal system and consequently cause adverse effects on people or animals.”(2) The further excerpt provides the understanding of the state of the science under the regulatory efforts: “although it is clear that certain environmental chemicals can interfere with normal hormonal processes, there is weak evidence that human health has been adversely affected by exposure to endocrine-active chemicals. However, there is sufficient evidence to conclude that adverse endocrine‐mediated effects have occurred in some wildlife species”. This was concluded in 2002, and in 2012 (latest report(2)) evidence base did not improved significantly. Especially it is weak for the effects in humans. It would not be a hyperbolae to say that there is no direct evidence that “endocrine disruptors” as natural or synthetic substances in the environment harms people.
Thirty years ago, in 1988, the Communist Party of the USSR held its 19th Conference, declaring a turn from the totalitarian past to a democratic future, to life built upon common human values. The country entered a deep transformation, ‘perestroika’. The year 1988 ended with Gorbachev meeting Reagan. In 3 years Russia would declare independence from the greater USSR. The Soviet Union had outlived its vitality and usefulness and voluntarily imploded. A useful comparator is Europe, 1945, ruined in the Great War. The next 30 years Europe saw flourishing of technology, trade, governance and prosperity. Though 30 years have elapsed since the Soviet fall, Russia remains in a churning transition of doubtful accomplishment unleavened by the passage of time. Indeed, since 1988, Russia has forfeited any real chance of improving the nation’s health and health care system.
Background: Despite Ukraine’s large population, few studies have examined social inequalities in health. This study describes Ukrainian educational inequalities in self-rated health and assesses how far psychosocial, material and behavioural factors account for the education gradient in health. Methods:Data were analyzed from the 2007 wave of the Ukrainian Longitudinal Monitoring Survey. Education was categorized as: lower secondary or less, upper secondary and tertiary. In logistic regressions of 5451 complete cases, stratified by gender, declaring less than average health was regressed on education, before and after adjusting for psychosocial, material and behavioural factors. Results: In analyses adjusted for socio-demographic characteristics, compared with those educated up to lower secondary level, tertiary education was associated with lower risk of less than average health for both men and women. Including material factors (income quintiles, housing assets, labour market status) reduced the association between education and health by 55–64% in men and 35–47% in women. Inclusion of health behaviours (physical activity, smoking, alcohol consumption and body mass index) reduced the associations by 27–30% in men and 19–27% in women; in most cases including psychosocial factors (marital status, living alone, trust in family and friends) did not reduce the size of the associations. Including all potential explanatory factors reduced the associations by 68–84% in men and 43–60% in women. Conclusions: The education gradient in self-rated health in Ukraine was partly accounted for by material and behavioural factors. In addition to health behaviours, policymakers should consider upstream determinants of health inequalities, such as joblessness and poverty.
Wave-shaped changes in the life span of Russian citizes remains mainly unexplained, but the last ten years provide some reasons to think that increase in the funding of the health care is accompanied by increase in the lenght of life