Russian Federation has made a strong legal commitment to the human right to health through the ratification of several key international human rights laws. Current public health care policies also demonstrate that Russian Federation has committed itself to provide the human right to health protection of people residing with its jurisdiction. All residents of Russia are eligible for medical care free of charge. Medical services are provided directly to patients by government health care providers. This includes general and specialist medical care, hospitalization, diagnostic laboratory services, dental care, maternity care and transportation, free drugs for disabled, medical rehabilitation, etc. The legal basis for the human right to health at the federal level is provided by a variety of legislative acts (codes, federal laws), presidential decrees, decisions and proposals of the government of the Russian Federation, and orders of the government and of the Ministry of Health and other ministries. The legal basis at the regional level is provided by legislative instruments enacted by the governments of the Subjects of Russian Federation.
With low take-up of both private health insurance and the existing public drug reimbursement scheme, it is thought that less than 5% of the Russian population have access to free outpatient drug treatment. This represents a major policy challenge for a country grappling with reforms of its healthcare system and experiencing low or no economic growth and significant associated reductions in spending on social services. In this paper, we draw on data from a recent Levada-Center survey to examine the attitudes and social solidarity of the Russian population towards drug policies in general and towards the introduction of a proposed voluntary drug insurance system in particular. In addition to being among the first to explore these important questions in the post-Communist setting, we make three important contributions to the emerging policy debates. First, we find that, if introduced immediately and without careful planning and preparation, Russia’s voluntary drug insurance scheme is likely to collapse financially due to the over-representation of high-risk unhealthy individuals opting in to the scheme. Second, the negative attitude of higher income groups towards the redistribution of wealth to the poor may further impede government efforts to introduce voluntary drug insurance. Finally, we argue that Russia currently lacks the breadth and depth of social solidarity necessary for implementing this form of health financing.
During the last decade, the role and meaning of research and technology organisations (RTOs) and their contribution to the innovation potential of countries has been questioned. In this paper, RTOs are understood as “…organisations with significant core government funding (25% or greater) which supply services to firms individually or collectively in support of scientific and technological innovation and which devote much of their capability (50% or more of their labour) to remaining integrated with the science base…” (Hales, 2001). Transitional economies like Russia face substantial challenges with national and regional innovation policies for supporting and enabling knowledge transfer. In this context, RTOs often maintain obsolete behavioural schemes of non-market public institutions isolated from the real economic sector. The purpose of this paper is to illustrate and explain some unexpected knowledge transfer phenomena crucial for efficient regional innovation policies using Russian RTOs as example.
Multimodal approaches are of growing interest in the study of neural processes. To this end much attention has been paid to the integration of electroencephalographic (EEG) and functional magnetic resonance imaging (fMRI) data because of their complementary properties. However, the simultaneous acquisition of both types of data causes serious artifacts in the EEG, with amplitudes that may be much larger than those of EEG signals themselves. The most challenging of these artifacts is the ballistocardiogram (BCG) artifact, caused by pulse-related electrode movements inside the magnetic field. Despite numerous efforts to find a suitable approach to remove this artifact, still a considerable discrepancy exists between current EEG-fMRI studies. This paper attempts to clarify several methodological issues regarding the different approaches with an extensive validation based on event-related potentials (ERPs). More specifically, Optimal Basis Set (OBS) and Independent Component Analysis (ICA) based methods were investigated. Their validation was not only performed with measures known from previous studies on the average ERPs, but most attention was focused on task-related measures, including their use on trial-to-trial information. These more detailed validation criteria enabled us to find a clearer distinction between the most widely used cleaning methods. Both OBS and ICA proved to be able to yield equally good results. However, ICA methods needed more parameter tuning, thereby making OBS more robust and easy to use. Moreover, applying OBS prior to ICA can optimize the data quality even more, but caution is recommended since the effect of the additional ICA step may be strongly subject-dependent.
Stuckler, King and McKee (2012) (hereafter, SKM) are unhappy that their bold claims that rapid mass privatisation was an important cause of post-communist mortality fluctuations have been disputed. In defending their claims, SKM variously accuse those questioning them of statistical manipulation and obscurantism , ideological bias, conflicts of interest, misrepresentation, denialism (e.g. as in climate change denial) and data torture. These are uncomfortable associations for any researcher. So, let me be clear, no one is denying the occurrence of unprecedented spikes inmortality and morbidity in the early 1990s across parts of the post-communist world; what is being questioned is the assertion that rapid mass privatisation was “a crucial determinant of differences in adult mortality trends”. This claim, stemming from a cross-national analysis covering 24 countries for up to 14 years, hardly merits associationwith the vast body of impressive scientific theory and evidence underpinning the link between environmental damage and climate change. Nevertheless, the discussion is important because it goes to the heart of what, when and how much can be claimed from small scale, cross-national data analysis. While SKM have raised an interesting question, their claims are far louder and bolder than the data justify and there are lessons, for social scientists and epidemiologists, that can be drawn from this. Moreover, their claim that it is wrong for their critics to explore their findings without putting forward and testing alternative hypotheses is anti-scientific (Popper, 2005, p.39): falsifiability defines the scientific endeavour. In their response to my article (Gerry, 2012) SKM state that I am part of a game of“statistical obscurantism”. They advance this allegation in four stages by: (i) revisiting the key facts and concepts; (ii) repeating discussion of the methodological challenges; (iii) comparing Russia (a mass privatiser) with Belarus (not a mass privatiser); and (iv) providing a set of regressions which they claim demonstrate “data torture”. I will take these in turn.
X-ray bone images are used in the areas such as bone age assessment, bone mass assessment and examination of bone fractures. Medical image analysis is a very challenging problem due to large variability in topologies, medical structure complexities and poor image modalities such as noise, low contrast, several kinds of artifacts and restrictive scanning methods. Computer aided analysis leads to operator independent, subjective and fast results.
In this study, near field effect of X-ray source is eliminated from hand radiographic images. Firstly, near field effect of X-ray source is modeled, then the parameters of the model are estimated by using genetic algorithms. Near field effect is corrected for all image pixels retrospectively.
Two different categories of images are analyzed to show the performance of the developed algorithm. These are original X-ray hand images and phantom hand images. Phantom hand images are used to analyze the effect of noise. Two performance criteria are proposed to test the developed algorithm: Hand segmentation performance and variance value of the pixels in the background. It is observed that the variance value of the pixels in the background decreases, and hand segmentation performance increases after retrospective correction process is applied.
Rigid amphipathic fusion inhibitors (RAFIs) are a family of nucleoside derivatives that inhibit the infectivity of several enveloped viruses by interacting with virion envelope lipids and inhibiting fusion between viral and cellular membranes. Here we tested the antiviral activity of two RAFIs, 5-(Perylen-3-ylethynyl)-arabino-uridine (aUY11) and 5-(Perylen-3-ylethynyl) uracil-1-acetic acid (cm1UY11) against African swine fever virus (ASFV), for which no effective vaccine is available. Both compounds displayed a potent, dose-dependent inhibitory effect on ASFV infection in Vero cells. The major antiviral effect was observed when aUY11 and cm1UY11 were added at early stages of infection and maintained during the complete viral cycle. Furthermore, virucidal assay revealed a significant extracellular anti-ASFV activity for both compounds. We also found decrease in the synthesis of early and late viral proteins in Vero cells treated with cm1UY11. Finally, the inhibitory effect of aUY11 and cm1UY11 on ASFV infection in porcine alveolar macrophages was confirmed. Overall, our study has identified novel anti-ASFV compounds with potential for future therapeutic developments.
The main reform of healthcare system in Russia had begun by introduction of compulsory healthcare insurance in 1993. Since this time, Russia went through number of steps of healthcare system modernization. Most attention was paid to the resource allocation, medical equipment and drug provision, the problem of the low quality of care was repeatedly addressed. Major direction of the efforts was the creation of obligatory technical standards of care.
I studied the volume of publication found in MEDLINE for period 1991-2014 and in the relevant Russian journals not covered by MEDLINE as well as legislation on health care introduced since 1991.
The reviewfound that despite some increase in volume of funding of health care system, and provision of incentives for quality, the progress with health care quality assurance is slow. The methodology of development of evidence based guidelines is not accepted. The control over conflict of interest of participants of the development of the guiding documents is not introduced. Economic factors are not systematically addressed in decisions on provision of health care interventions. The practice of the health technology assessment does not exist. The system of financial incentives for the quality of care dominates and is developing without evidence based criteria and evidence of its efficacy.
The documents prescribing quality healthcare are developing non-systematically in Russia. The acceptance of the modern methodology of guideline development, health technology assessment and control over conflict of interest is needed as a minimum prerequisite for the progress in the quality assurance.
At the beginning of the 20th century, medicine as an academic discipline and a vocational training was quite similar in Russia and in western Europe. Most professors in Russian medical faculties had some international training. Pirogov, Sechenov, Mechnikoff, and Pavlov, just to name a few, were not only exceptional scientists but typical with their international training and research experience. Yet medicine as a service to the public was under developed. The access to a nurse or doctor was very limited, as described depressingly clearly in Anton Checkhov’s short stories. Some doctors devotedly served their poor compatriots. Being prone to socialist views, these doctors created the important argument against the Tsarist regime
Today in Russia and all over the world significant efforts are invested in building biobanks—specialized facilities for storing biological materials for research and medical purposes. The successful functioning of biobanks depends directly on people’s willingness to donate their biological materials. No previous studies of people’s attitudes toward donations to biobanks have been undertaken in Russia. The goal of this study was to measure attitudes toward biobank donation among young Russians and to evaluate potential sociodemographic and personality factors that play a role in a person’s readiness to become a donor. Data from 542 students at Saint Petersburg State University were collected from group-administered paper-and-pencil questionnaires. Only one-fifth of the students knew about the existence of biobanks, while roughly the same number believed they might have heard something about them but were not absolutely certain. However, the students indicated a relatively high level of readiness to become biobank donors (74%). Willingness to be a biobank donor was correlated significantly with studying biology and was just modestly correlated with students’ values. In addition, we found gender-specific differences in the biobank characteristics that students felt were important in making a decision about whether to donate. The study demonstrated that today the attitudes of the general population (at least, those of the subgroup studied, students) do not pose a problem for the further development of biobanking in Russia.
Purpose: Ovarian cancer (OvCa) progression mainly takes place by intraperitoneal spread. Adhesion of tumor cells to the mesothelial cells which form the inner surface of the peritoneum is a crucial step in this process. Cancer cells use in principle different molecules of the leukocyte adhesion cascade to facilitate adhesion. This cascade is initiated by selectin-ligand interactions followed by integrin - extracellular matrix protein interactions. Here we address the question whether all tumor cells pre- dominantly employ selectin-dependent leukocyte-like adhesion cascade (SDAC) or whether they use integrin mediated adhesion for OvCa progression as well.
Methods: A comparative transcriptomic analysis of the human OvCa cell lines OVCAR8 and SKOV3 was performed. Intraperitoneal xenograft model of OVCAR8 cells was used to determine whether there is a correlation between SDAC gene expression and the metastatic potential of the control cells and the cells overexpressing c-Fos. Transcriptomic analysis of OVCAR8 and SKOV3 samples was performed using microarrays.
Results: One-third of the protein-coding genes involved in SDAC exhibited lower expression levels in OVCAR8 than in SKOV3 cells. In contrast to SKOV3 cells, c-Fos overexpression in OVCAR8 cells did not significantly influence the expression of SDAC genes. Intraperitoneal xenograft model of OVCAR8 cells unexpectedly demonstrated that the aggressiveness of OVCAR8 tumors was not depended on the c-Fos expression level and was comparable to that of SKOV3 control tumors. Gene expression analysis of tu- mors suggests that SKOV3-derived tumor progression was mainly depended on SDAC. Progression of OVCAR8 tumors relied on other cell adhesion molecules that do not interact with selectins. Conclusions: High expression of c-Fos in ovarian cancer cells is not always associated with reduced metastatic potential. Low expression level of SDAC genes may not ensure low OvCa metastatic potential hence alternative adhesion mechanisms involving laminin-integrin interactions exist as well.
Aims: To describe HIV-related risk behaviours, HIV testing and HIV status among people who inject drugs (PWIDs) in the 2000 in European countries with highprevalence HIV epidemics among PWID. Methods: Data from 12 cross-sectional studies among PWID from seven countries were used. Meta-analysis was used to synthesize the data and meta-regression to explain heterogeneity [in addition to deriving adjusted odds ratios (AORmeta)]. Results: Data on 1791 PWID from western (the West) and 3537 from central and eastern (the East) European countries were available. The mean age of participating PWIDs was 30.6 years (SD 7.9), 75% were men, and 36% [95% confidence interval 34–37%) were HIV-infected (30% West, 38% East); 22% had not previously been tested for HIV. The prevalence of reported high-risk behaviour was significantly higher among PWID from the East. Comparison of HIV-infected and uninfected PWID within countries yielded similar results across all countries: HIV-infected PWID were less likely to be sexually active [AORmeta 0.69 (0.58–0.81)], reported less unprotected sex [AORmeta 0.59 (0.40–0.83)], but reported more syringe sharing [AORmeta 1.70 (1.30– 2.00)] and more frequent injecting [AORmeta 1.40 (1.20–1.70)] than their HIVuninfected counterparts. Conclusion: Despite the absolute differences in reported risk behaviours among PWID in western and eastern Europe, the associations of risk behaviours with HIV status were similar across the sites and regions. There is a substantial potential for further HIV transmission and acquisition based on the continuous risk behaviours reported. HIV prevention and harm reduction interventions targeting PWID should be evaluated.
Background: Accurate information on stroke burden in men and women are important for evidence-based healthcare planning and resource allocation. Previously, limited research suggested that the absolute number of deaths from stroke in women was greater than in men, but the incidence and mortality rates were greater in men. However, sex differences in various metrics of stroke burden on a global scale have not been a subject of comprehensive and comparable assessment for most regions of the world, nor have sex differences in stroke burden been examined for trends over time. Methods: Stroke incidence, prevalence, mortality, disability-adjusted life years (DALYs) and healthy years lost due to disability were estimated as part of the Global Burden of Disease (GBD) 2013 Study. Data inputs included all available information on stroke incidence, prevalence and death and case fatality rates. Analysis was performed separately by sex and 5-year age categories for 188 countries. Statistical models were employed to produce globally comprehensive results over time. All rates were age-standardized to a global population and 95% uncertainty intervals (UIs) were computed. Findings: In 2013, global ischemic stroke (IS) and hemorrhagic stroke (HS) incidence (per 100,000) in men (IS 132.77 (95% UI 125.34-142.77); HS 64.89 (95% UI 59.82-68.85)) exceeded those of women (IS 98.85 (95% UI 92.11-106.62); HS 45.48 (95% UI 42.43-48.53)). IS incidence rates were lower in 2013 compared with 1990 rates for both sexes (1990 male IS incidence 147.40 (95% UI 137.87-157.66); 1990 female IS incidence 113.31 (95% UI 103.52-123.40)), but the only significant change in IS incidence was among women. Changes in global HS incidence were not statistically significant for males (1990 = 65.31 (95% UI 61.63-69.0), 2013 = 64.89 (95% UI 59.82-68.85)), but was significant for females (1990 = 64.892 (95% UI 59.82-68.85), 2013 = 45.48 (95% UI 42.427-48.53)). The number of DALYs related to IS rose from 1990 (male = 16.62 (95% UI 13.27-19.62), female = 17.53 (95% UI 14.08-20.33)) to 2013 (male = 25.22 (95% UI 20.57-29.13), female = 22.21 (95% UI 17.71-25.50)). The number of DALYs associated with HS also rose steadily and was higher than DALYs for IS at each time point (male 1990 = 29.91 (95% UI 25.66-34.54), male 2013 = 37.27 (95% UI 32.29-45.12); female 1990 = 26.05 (95% UI 21.70-30.90), female 2013 = 28.18 (95% UI 23.68-33.80)). Interpretation: Globally, men continue to have a higher incidence of IS than women while significant sex differences in the incidence of HS were not observed. The total health loss due to stroke as measured by DALYs was similar for men and women for both stroke subtypes in 2013, with HS higher than IS. Both IS and HS DALYs show an increasing trend for both men and women since 1990, which is statistically significant only for IS among men. Ongoing monitoring of sex differences in the burden of stroke will be needed to determine if disease rates among men and women continue to diverge. Sex disparities related to stroke will have important clinical and policy implications that can guide funding and resource allocation for national, regional and global health programs.
Background Accession of 10 Central and Eastern European (CEE) countries to the EU resulted in the largest migratory influx in peacetime British history. No information exists on the sexual behaviour of CEE migrants within the UK. The aim of this study was to assess the sexual lifestyles and health service needs of these communities.
Methods A survey, delivered electronically and available in 12 languages, of migrants from the 10 CEE accession countries recruited from community venues in London following extensive social mapping and via the Internet. Reported behaviours were compared with those from national probability survey data.
Results 2648 CEE migrants completed the survey. Male CEE migrants reported higher rates of partner acquisition (adjusted OR (aOR) 2.1, 95% CI: 1.3 to 2.1) and paying for sex (aOR 3.2, 95% CI: 2.5 to 4.0), and both male and female CEE migrants reported more injecting drug use (men: aOR 2.2, 95% CI: 1.3 to 3.9; women: aOR 3.0, 95% CI 1.1 to 8.1), than the general population; however, CEE migrants were more likely to report more consistent condom use and lower reported diagnoses of sexually transmitted infections (STI). Just over 1% of respondents reported being HIV positive. Most men and a third of women were not registered for primary care in the UK.
Discussion CEE migrants to London report high rates of behaviours associated with increased risk of HIV/STI acquisition and transmission. These results should inform service planning, identify where STI and HIV interventions should be targeted, and provide baseline data to help evaluate the effectiveness of such interventions.
Rigid amphipathic fusion inhibitors are potent broad-spectrum antivirals based on the perylene scaffold, usually decorated with a hydrophylic group linked via ethynyl or triazole. We have sequentially simplified these structures by removing sugar moiety, then converting uridine to aniline, then moving to perylenylthiophenecarboxilic acids and to perylenylcarboxylic acid. All these polyaromatic compounds, as well as antibiotic heliomycin, still showed pronounced activity against tick-borne encephalitis virus (TBEV) with limited toxicity in porcine embryo kidney (PEK) cell line. 5-(Perylen-3-yl)-2-thiophenecarboxylic acid (5a) showed the highest antiviral activity with 50% effective concentration of approx. 1.6 nM.
The extraction of task-related single trial ERP information has recently gained much interest, not only in studies on ERPs alone, but also in simultaneous EEG-fMRI applications. The investigation of these single trial data, however, requires a specific decomposition to retrieve the task-related activity from the originally acquired raw data. In this study, this is achieved with source extraction based on parallel factor analysis (PARAFAC). We show that differences between distinct task-related conditions can be captured in the trial signatures of specific PARAFAC components when applied to single trial ERP data arranged in channels x time x trials arrays. The performance of this method is illustrated for data from a visual detection task, acquired in normal circumstances and simultaneously with fMRI. We also checked whether the obtained trial signatures correlated with the fMRI data, but with this approach no significant results were found.
The scale-up of tobacco control, especially after the adoption of the Framework Convention for Tobacco Control, is a major public health success story. Nonetheless, smoking remains a leading risk for early death and disability worldwide, and therefore continues to require sustained political commitment. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) offers a robust platform through which global, regional, and national progress toward achieving smoking-related targets can be assessed.
We synthesized 2,818 data sources with spatiotemporal Gaussian process regression and produced estimates of daily smoking prevalence by sex, age group, and year for 195 countries and territories from 1990 to 2015. We analyzed 38 risk-outcome pairs to generate estimates of smoking-attributable mortality and disease burden, as measured by disability-adjusted life years (DALYs). We then did a cohort analysis of smoking prevalence by birth-year cohort to better understand temporal age patterns in smoking. We also did a decomposition analysis, in which we parsed out changes in all-cause smoking-attributable DALYs due to changes in population growth, population aging, smoking prevalence, and risk-deleted DALY rates. Finally, we explored results by level of development using the Socio-demographic Index (SDI).
Worldwide, the age-standardized prevalence of daily smoking was 25.0% (95% uncertainty interval [UI] 24.2–25.7) for men and 5.4% (5.1–5.7) for women, representing 28.4% (25.8–31.1) and 34.4% (29.4–38.6) reductions, respectively, since 1990. A greater percentage of countries and territories achieved significant annualized rates of decline in smoking prevalence from 1990 to 2005 than in between 2005 and 2015; however, only two countries had significant annualized increases in smoking prevalence between 2005 and 2015 (Congo for men and Kuwait for women). In 2015, 11.5% of global deaths (6.4 million [95% UI 5.7–7.0 million]) were attributable to smoking worldwide, of which 52.2% took place in four countries (China, India, the US, and Russia). Smoking was ranked among the five leading risk factors by DALYs in 109 countries and territories in 2015, rising from 88 geographies in 1990. In terms of birth cohorts, male smoking prevalence followed similar age patterns across levels of SDI, whereas much more heterogeneity was found in age patterns for female smokers by level of development. While smoking prevalence and risk-deleted DALY rates mostly decreased by sex and SDI quintile, population growth, population aging, or a combination of both, drove rises in overall smoking-attributable DALYs in low-SDI to middle-SDI geographies between 2005 and 2015.
The pace of progress in reducing smoking prevalence has been heterogeneous across geographies, development status, and sex, and as highlighted by more recent trends, maintaining past rates of decline should not be taken for granted, especially in women and in low-SDI to middle-SDI countries. Beyond the effect of the tobacco industry and societal mores, a crucial challenge facing tobacco control initiatives is that demographic forces are poised to heighten smoking’s global toll, unless progress in preventing initiation and promoting cessation can be substantially accelerated. Greater success in tobacco control is possible but requires effective, comprehensive, and adequately implemented and enforced policies, which might in turn require global and national levels of political commitment beyond what has been achieved during the past 25 years.
GBD 2015 Tobacco Collaborators. Smoking prevalence and attributable disease burden in 195 countries and territories, 1990–2015: a systematic analysis from the Global Burden of Disease Study 2015. The Lancet. 2017 April 7;14:48. http://dx.doi.org/10.1016/S0140-6736(17)30819-X
This article discusses the adequacy of human resources for the sustainable development of the ter¬ritories of the Russian Arctic. By using the example of Murmansk oblast, the negative dynamics of the pop¬ulation and labor potential is shown, actual forecasts of the declining life expectancy are given, and reasons for the high mortality rate, especially among working¬age people, are discussed. In conclusion, the need for priority measures to overcome the increasing migration outside the region and the development of the social and healthcare areas is given
This paper considers the problem of searching for dependences between the cancer occurrence and associated diseases. A statistical method that yields blocks of diseases with the most significant influence on cancer morbidity is described. Based on American data on cause-specific mortality, we select the diseases that have the maximum differences between the distributions of associated diseases among people who died from cancer or have cancer as an associated disease and among people who did not have cancer. A medical interpretation of the obtained results is discussed.
The proportion of people living with HIV (PLH) in care and on antiretroviral therapy (ART) in Russia is lower than in Sub-Saharan Africa (1). This is undoubtedly due to a variety of systems and structural issues related to poor treatment access, linkage and care delivery models. However, little research has explored the reasons that PLH are not in care from their own perspectives. This information can help to guide the development of approaches for improving HIV care engagement in the country.MATERIALS AND METHODS:
In-depth interviews were undertaken with 80 PLH in St. Petersburg who had never been in HIV medical care, had previously been out of care, or had always been in care. Participants were recruited through online PLH forums and Websites, outreach needle exchange and non-government organisation (NGO) programs, and chain referral. The interviews elicited detailed information about participants' experiences and circumstances responsible for being out of care, and factors contributing to nonretention in HIV treatment. Verbatim transcriptions of the interviews were coded and analyzed using MAXQDA software to identify emerging themes.RESULTS:
Two types of care engagement barriers most often emerged. Some related to medical services, and others to the family and social environment. The most frequent medical service barriers were poor treatment infrastructure conditions and access; dissatisfaction with quality of services and medical staff; and concerns over confidentiality and HIV status disclosure. Social barriers were fears of potential harm to family relationships, negative consequences if status became known at work, and public stigmatization and myths associated having an HIV+ status. Social support from the PLH community and from family and close friends facilitated care engagement, as did motivation to take care of oneself and one's family. Most participants also described circumstances in which engaging into HIV care was brought about by an urgent issue (opportunistic infections) or was enforced through hospitalization or imprisonment. Trust in one's doctor and simply not wanting to die were also common motives.CONCLUSIONS:
Stigma was a major barrier to care engagement, including fear that others would learn of one's HIV+ status, whether at work, in one's family, or in the general community. By contrast, support from family, friends and the PLH community contributed to care engagement.