Теоретические аспекты проблемы потребительского выбора в здравоохранении
Alcohol use is a leading risk factor for death and disability, but its overall association with health remains complex given the possible protective effects of moderate alcohol consumption on some conditions. With our comprehensive approach to health accounting within the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we generated improved estimates of alcohol use and alcohol-attributable deaths and disability-adjusted life-years (DALYs) for 195 locations from 1990 to 2016, for both sexes and for 5-year age groups between the ages of 15 years and 95 years and older.
Using 694 data sources of individual and population-level alcohol consumption, along with 592 prospective and retrospective studies on the risk of alcohol use, we produced estimates of the prevalence of current drinking, abstention, the distribution of alcohol consumption among current drinkers in standard drinks daily (defined as 10 g of pure ethyl alcohol), and alcohol-attributable deaths and DALYs. We made several methodological improvements compared with previous estimates: first, we adjusted alcohol sales estimates to take into account tourist and unrecorded consumption; second, we did a new meta-analysis of relative risks for 23 health outcomes associated with alcohol use; and third, we developed a new method to quantify the level of alcohol consumption that minimises the overall risk to individual health.
Globally, alcohol use was the seventh leading risk factor for both deaths and DALYs in 2016, accounting for 2·2% (95% uncertainty interval [UI] 1·5–3·0) of age-standardised female deaths and 6·8% (5·8–8·0) of age-standardised male deaths. Among the population aged 15–49 years, alcohol use was the leading risk factor globally in 2016, with 3·8% (95% UI 3·2–4·3) of female deaths and 12·2% (10·8–13·6) of male deaths attributable to alcohol use. For the population aged 15–49 years, female attributable DALYs were 2·3% (95% UI 2·0–2·6) and male attributable DALYs were 8·9% (7·8–9·9). The three leading causes of attributable deaths in this age group were tuberculosis (1·4% [95% UI 1·0–1·7] of total deaths), road injuries (1·2% [0·7–1·9]), and self-harm (1·1% [0·6–1·5]). For populations aged 50 years and older, cancers accounted for a large proportion of total alcohol-attributable deaths in 2016, constituting 27·1% (95% UI 21·2–33·3) of total alcohol-attributable female deaths and 18·9% (15·3–22·6) of male deaths. The level of alcohol consumption that minimised harm across health outcomes was zero (95% UI 0·0–0·8) standard drinks per week.
Alcohol use is a leading risk factor for global disease burden and causes substantial health loss. We found that the risk of all-cause mortality, and of cancers specifically, rises with increasing levels of consumption, and the level of consumption that minimises health loss is zero. These results suggest that alcohol control policies might need to be revised worldwide, refocusing on efforts to lower overall population-level consumption.
The article investigates the risks of innovative projects in health care. On the basis of surveys of industry experts and study the results of scientific studies on the health risks are identified and analyzed specific risks of innovative projects in the field of public health. the authors proposed a method of calculating the integral indicator of risk, investigated by qualitative analysis. The study used in the risk assessment of the innovative project on the development and market introduction of the medical device.
This article considers the main stages of development and problems discussed in the research field known as chaplaincy studies. These studies arose in the second half of the twentieth century in the English-language tradition as a result of the improved practical understanding of the experiences of non-parish ministries in Christian churches across various secular institutions. Modern chaplaincy studies bring together practitioners from different sectors, such as representatives of the academy and those who combine both academic and chaplaincy careers. Other distinctive features of the field are the dominance of studies carried out in English-speaking countries, the uneven study of individual sectors and analogues of non-parish Ministries that appear outside the Christian denominations. Due to the public importance of health care, the experience of the chaplains in this sector is often studied and can often serve as a point of comparison for researchers studying other sectors. This article considers in more detail how the work of priests in hospitals, peripheral to organized religion, was professionalized and reformulated in terms of providing universal spiritual and pastoral care to patients, their relatives and medical personnel, regardless of religious affiliation and beliefs. Alongside this professionalization process, these institutions experienced the transformative impact of neoliberal reforms. On the one hand, the increasing marginalization of hospital chaplains in relation to organized religion is explained in the context of religious dedifferentiation. This marginalization has become an important resource for Christian churches, giving the latter access to the non-churched majority. On the other hand, this resource is producing a new, reflective priest-researcher, for whom it is important to specialize in working with a certain category of patients, to combine pastoral work with counseling and solve individual problems. Additionally, it has become crucial developing techniques of listening and observation, as well as expanding methodological tools and publishing research results.
Plus d'un quart de siècle après la fin de l'URSS, la libéralisation des prix en Russie et l'adoption de différents modèles pour les républiques d'Asie centrale ont des répercussions majeures sur le bilan de ces pays. La perte brutale des acquis socio-économiques au sein d'une population encore largement marquée par un mode de fonctionnement soviétique a vulnérabilisé des pans entiers de ces sociétés, exacerbant les inégalités. La reconfiguration des mobilités (exil, déplacements forcés, migrations économiques et environnementales) implique un jeu d'échelles nouveau qui nécessite de s'intéresser aux conditions d'origine des migrants, aux stratégies migratoires et à la recomposition de sociétés d'origine. Ces derniers sont en effet dépendants des contextes, politique et économique notamment, du pays d'accueil : la Russie. Ils sont également liés par différentes formes d'allégeance aux réseaux et aux systèmes de loyauté. Dans ces sociétés post-soviétiques, l'assurance de la survie de la communauté, de la famille, de la parentèle est à rechercher dans le retissage de normes et de réseaux encastrés qui ont préexisté à la fin de l'URSS et se sont remodelés face à de nouvelles contingences. Mais la circulation des migrants les expose à des risques sanitaires et épidémiologiques. Les enjeux de l'accès aux soins se posent de manière aiguë. Les politiques préventives concernant notamment l'infection par VIH/SIDA, les hépatites, la tuberculose sont confrontées à une disqualification du système de santé publique et s'accompagnent de situations très anxiogènes lors des migrations pour de nombreux ressortissants d'Asie centrale. Les vulnérabilités sont donc multidimensionnelles et les représentations du corps et de la maladie jouent un rôle non négligeable dans les mentalités. Aussi la santé des migrants représente-t-elle un enjeu majeur dans les républiques post-soviétiques mais aussi universel dans le monde globalisé qui les façonne.