Obesity and education in three countries of the Central and Eastern Europe: the HAPIEE study

The international pattern of obesity is only partly understood. While in developed countries the association between education and obesity is inverse, in the developing world social distribution of obesity is less predictable. We examined obesity patterns in three countries of Central and Eastern Europe (CEE): Russia, Poland and the Czech Republic, middle-income post-communist countries undergoing social and economic transition. The prevalence of obesity was inversely associated with education of individuals in our three samples of Central and Eastern European populations. In agreement with previous findings, the inverse socioeconomic gradient was more pronounced in the Czech Republic and Poland, countries with higher Gross National Product (GNP) than Russia. In addition, obesity was more common in Russian women than in Czech or Polish women while Russian men were less obese than Czech or Polish men. These findings are consistent with the hypothesis that the social gradient in obesity differs between populations--it is more likely to find a reverse association between socioeconomic position and prevalence of obesity in the more westernized countries with higher population income.     

Access to health care for Roma children in Central and Eastern Europe: findings from a qualitative study in Bulgaria

Background

Despite the attention the situation of the Roma in Central and Eastern Europe has received in the context of European Union enlargement, research on their access to health services is very limited, in particular with regard to child health services.

Methods

50 qualitative in-depth interviews with users, providers and policy-makers concerned with child health services in Bulgaria, conducted in two villages, one town of 70,000 inhabitants, and the capital Sofia.

Results

Our findings provide important empirical evidence on the range of barriers Roma children face when accessing health services. Among the most important barriers are poverty, administrative and geographical obstacles, low levels of parental education, and lack of ways to accommodate the cultural, linguistic and religious specifics of this population group.

Conclusion

Our research illustrates the complexity of the problems the Roma face. Access to health care cannot be discussed in isolation from other problems this population group experiences, such as poverty, restricted access to education, and social exclusion.     

Travel experiences in Central and Eastern Europe: Romania: the general's kisses

The public face of Rumania is characterized by extreme contrasts between very poor and very rich people. The state is near bankruptcy, industry is slow in recovering from many years of madcap rule: politics, tourism and agriculture are in chaos, doctors are seriously underpaid and good health care is only available to the newly rich. World Bank loans have been largely spent on sophisticated hospital instrumentation, but the primary health care barely manages to survive. The capital has seriously suffered from Ceausescu's megalomania and many historic cities show the remnants of past glory. The country sometimes resembles a disorganized beehive. Rumanians try to steer a middle course between bouts of self-pity and their intense wish to become full members of the European Union. They are not averse to play-acting and one should not be surprised to receive a cordial accolade from a medical professor who chairs government committee meetings in full general's attire.     

Pediatric environmental medicine in Eastern Central Europe

Pediatric environmental medicine in Central Eastern Europe needs support and development on national, institutional and individual basis. This situation is quantitatively, but not fundamentally different from what is to be found in Central Europe.     

Perspectives of family medicine in Central and Eastern Europe

INTRODUCTION: In the last decade of the 20th century, the countries of Central and Eastern Europe (CEE) have experienced rapid changes in health policies. This process was largely supported by international grants. After this support has ended, it is important to keep up with the development, developing its own strategies and priorities. Aims and methods. The aim of the paper is to make a proposal for the future development of the discipline in CEE countries. The proposal is based on reports on an invitational conference that was organized for the key representatives of family medicine from CEE countries. For the purpose of this paper, additional information about the situation was gathered from literature reviews, country visits and personal interviews. RESULTS: Information shows that although family medicine has been formally recognized and introduced in university curricula, there is a very big difference in its academic position. Postgraduate training has been established in all CEE countries, according to the European Directive. Quality measures such as the development and implementation of guidelines and the re-certification procedure have also been formally introduced, but its quality varies. The key areas of concern are atomization of practices, unsatisfactory payment systems, lack of academic infrastructure and unsatisfactory continuous professional development. On the other hand, examples of good practice exist and need to be promoted. CONCLUSION: There is a need for continuous exchange of expertise within the countries. The paper will serve as a discussion paper for the next meeting of experts from CEE countries.     

Health insurance coverage in Central and Eastern Europe: trends and challenges

Health insurance systems in Central and Eastern Europe have evolved in different ways from the centralized health systems inherited from the Soviet era, but there remain common trends and challenges in the region. Health spending is low in comparison to the spending of pre-2004 European Union members, but population aging, medical technology, economic growth, and heightened expectations will generate major spending pressures. Social health insurance is the dominant model in the region, but coverage is uneven. Key3reform issues include identifying ways to encourage additional investment in the health sector; and defining formal benefit packages, copayments, and the role of private insurance.     

Air pollution and mortality in Central and Eastern Europe: An estimate of the impact

Air pollution is severe in some areas of Central and EasternEurope but the quality and representativeness of measurementsare not consistent. Studies in the Czech Republic and Polandhave shown an impact of air pollution on overall mortality,post-neonatal mortality and lung cancer. Estimates in this papersuggest that air pollution may cause up to 3% of all-cause,all-age mortality in the Czech Republic, which is some 9% ofthe mortality gap between this country and Western Europe. Theimpact in other countries of Central and Eastern Europe is probablysmaller.     

HTA and decision-making processes in Central,Eastern and South Eastern Europe: Results from a survey

Objective

To gain knowledge and insights on health technology assessment (HTA) and decision-making processes in Central, Eastern and South Eastern Europe (CESEE) countries.

Social representations of HIV/AIDS in Central and Eastern Europe

Although a relatively recent epidemic, HIV is now increasing in Eastern Europe faster than anywhere else in the world. In the study reported in this paper, we interviewed 511 business people and health professionals in five Central and Eastern European nations: Estonia, Georgia, Hungary, Poland and Russia, deriving our questions primarily from a Social Representations perspective. Respondents also freely completed their associations with the stimulus word 'AIDS'. Our findings indicate that, although there is considerable agreement about the threat posed by the epidemic, there are also notable cultural differences in attributions about the origin and spread of the virus and the nature of those groups at risk of infection. These findings are interpreted in the light of the historical legacies of the Communist era, as well as the real economic and social challenges faced by the population of this region.     

Welding and lung cancer in Central and Eastern Europe and the United Kingdom

Occupation as a welder has been associated with a 25%-40% increase in lung cancer risk. This study aims to elucidate to what extent confounding by smoking and asbestos drives this association and to evaluate the role of welding-related exposures such as chromium. The study included 2,197 male incident lung cancer cases and 2,295 controls from Romania, Hungary, Poland, Russia, Slovakia, the Czech Republic, and the United Kingdom from 1998 to 2001. Information on risk factors was collected through face-to-face interviews. Experts assessed exposure to 70 agents, and risk estimates were adjusted for smoking and occupational exposures. Occupation as a welder/flame cutter (prevalence controls: 3.7%) was associated with an odds ratio of 1.36 (95% confidence interval (CI): 1.00, 1.86) after adjustment for smoking and occupational exposures including asbestos. An odds ratio of 1.18 (95% CI: 1.01, 1.38) was found for welding fumes (prevalence controls: 22.8%), increasing to 1.38 for more than 25 exposure years (95% CI: 1.09, 1.75). A duration-response association was also observed for mild steel welding without chromium exposure. In this population, occupational exposure to welding fumes accounted for approximately 4% of lung cancer cases, to which both stainless and mild steel welding contributed equally. Given that welding remains a common task for many workers, exposure to welding fumes represents an important risk factor for lung cancer.