The welfare costs of HIV/AIDS in Eastern Europe: an empirical assessment using the economic value-of-life approach

Based on the aggregation of individual willingness-to-pay for a statistical life, we calibrate an inter-temporal optimisation model to determine the aggregate welfare loss from HIV/AIDS in 25 Eastern European countries. Assuming a discount rate of 3%, we find a total welfare loss for the whole region that exceeds US $800 billion, approximately 10% of the region’s annual GDP between 1995 and 2001. Although prevalence and incidence rates diverge sharply between countries—with central Europe far less affected than major countries in the Commonwealth of Independent States and the Baltics—the epidemic is likely to spread to all countries unless a coherent strategy of prevention and treatment is backed up by substantial increases in healthcare investments. The sheer size of this task and the international nature of the epidemic render this one of the most important current challenges for all of Europe.     

The global burden of injuries

The traditional view of injuries as "accidents", or random events, has resulted in the historical neglect of this area of public health. However, the most recent estimates show that injuries are among the leading causes of death and disability in the world. They affect all populations, regardless of age, sex, income, or geographic region. In 1998, about 5.8 million people (97.9 per 100,000 population) died of injuries worldwide, and injuries caused 16% of the global burden of disease. Road traffic injuries are the 10th leading cause of death and the 9th leading cause of the burden of disease; self-inflicted injuries, falls, and interpersonal violence follow closely. Injuries affect mostly young people, often causing long-term disability. Decreasing the burden of injuries is among the main challenges for public health in the next century--injuries are preventable, and many effective strategies are available. Public health officials must gain a better understanding of the magnitude and characteristics of the problem, contribute to the development and evaluation of injury prevention programs, and develop the best possible prehospital and hospital care and rehabilitation for injured persons.     

Investigación en salud pública: ¿hay diferencias entre los países del norte,el sur y el este de Europa? Una perspectiva desde las asociaciones nacionales de salud pública

IntroductionResearch provides the important evidence base for public health practice. We sought to compare the current support for public health research within European countries.MethodsWithin a collaborative study SPHERE (Strengthening Public Health Research in Europe), we developed an e-mail questionnaire and sent it to 93 representatives of national member associations of the European Public Health Association. We compared the answers with reference to tree macro-areas: Northern, Southern and Eastern Europe.ResultsWe gained responses for 22 of 39 European countries (56% country response rate). Current priorities at national level were: health service and patient safety for Northern Europe; infectious disease, health service and cardiovascular disease for Southern Europe; and food safety and nutrition, environmental and occupational health for Eastern Europe. Respondents gave fewer priorities for international research. In the North Europe the priorities empathized were health promotion, prevention and education (26.3%) together the injuries and alcohol habits (26.3%).ConclusionSupport for public-health research differs across Europe, and barriers to undertaking better research include structures and sufficient personnel. National public health associations and public authorities should cooperate in order to find effective answers to common problems.     

Gesundheitswissenschaften in Europa

Background

Research provides an important evidence base for public health practice. This was the basis for a comparison of current support for public health research within European countries.

Methods

Within a collaborative study SPHERE (Strengthening Public Health Research in Europe) an e-mail questionnaire concerning current priorities in public health research was developed, which was sent to 93 representatives of national member associations of the European Public Health Association (EUPHA). The answers were compared with reference to three macro-areas: Northern, Southern and Eastern Europe.

Results

Responses were received from 22 out of 39 European countries (56% country response rate). Current priorities at national level were health services and patient safety for Northern Europe, infectious diseases, health services and cardiovascular diseases for Southern Europe and food safety and nutrition, environmental and occupational health for Eastern Europe. Respondents reported fewer priorities in international research. In Northern Europe the priorities emphasized were health promotion, prevention and education (26.3%), injuries and alcohol habits (26.3%), in Southern and Eastern Europe health economics, health impact assessment and evaluations of services and programmes were prioritized by 30% and 41.7%, respectively.

Conclusions

Support for public health research differs across Europe, and barriers to undertaking better research include structural obstacles and insufficient personnel. National public health associations and public authorities should cooperate in order to find effective answers to common problems.     

Homosexuality and HIV/AIDS prevention: the challenge of transferring lessons learned from Western Europe to Central and Eastern European Countries

In order to stem the rapidly growing HIV/AIDS epidemics in Eastern Europe a transfer of prevention know-how and experience from Western European countries is necessary. The success of such a transfer is contingent on addressing a number of challenging issues. Monolithic ideas of East/West difference need to give way to the growing empirical evidence which not only shows a tremendous diversity but also many similarities among the 51 countries within the WHO European region. These include similarities regarding sexual attitudes and HIV prevention needs. Western constructs such as a gay identity need to be de-emphasized however, when it comes to promoting human rights (and thus improving HIV prevention for men who have sex with men) in Central and Eastern Europe. In asking the question of what should be transferred from Western Europe to other countries, both the strengths and weaknesses of the last 20 years of prevention need to be considered. In terms of Western European research the strength lies in identifying the social structural causes of HIV transmission. In terms of practice, the successes of instituting country-level structures while also working within the gay community are to be emphasized. Short-comings are evident in terms of reaching men of lower socio-economic status, cultural minorities and sex workers. On such questions, the expertise of Europe as a whole is needed in order to find new answers.     

The current perspective on tick-borne encephalitis awareness and prevention in six Central and Eastern European countries: report from a meeting of experts convened to discuss TBE in their region

Tick-borne encephalitis (TBE) is a potentially life-threatening disease in humans and is caused by a flavivirus spread by infected ticks (Ixodes ricinus and Ixodes persulcatus). TBE is endemic across much of Central and Eastern Europe and the incidence is increasing, with numbers estimated to be as many as 8755 cases per year. The reasons for this increase are multi-faceted and may involve improvements in diagnosis and reporting of TBE cases, increases in recreational activities in areas inhabited by infected ticks and changes in climatic conditions affecting tick habitats. Vaccination is the most effective method of preventing TBE; following a successful nationwide vaccination campaign in Austria, the annual number of TBE cases fell to about 10% of those reported in the pre-vaccination era.This report describes the findings of a group of leading experts from six Central and Eastern European countries who convened to discuss TBE in their region during the 28th Annual Meeting of the European Society for Paediatric Infectious Diseases (ESPID) Nice, France, 4-8 May 2010.     

Trends in injury mortality among young people in the European Union: a report from the EURORISC working group.

PURPOSE: To examine the trends in injury mortality among young people aged 15-24 years residing in the 15 current member states of the European Union between 1984 and 1993. METHODS: As part of a European Commission-funded project entitled European Review of Injury Surveillance and Control (EURORISC), mortality data for all externally caused physical injuries (International Classification of Disease Codes E800-999) were obtained from the World Health Organization. Data were analyzed to generate age-specific injury mortality rates and proportional differences in rates over the study period. Linear regression was used to represent the linear component of the mortality profile. RESULTS: Almost a quarter of a million young people died as a result of sustaining an externally caused physical injury (either unintentional or intentional) in the study countries between 1984 and 1993. Injury accounted for two-thirds of all deaths in this age group. Over three-quarters (76%) of deaths were due to unintentional injury, a further 17% to self-inflicted injuries, and the remaining 7% to homicide and other violent causes. Motor vehicle traffic fatalities accounted for 84% of unintentional injury deaths. Although a decline in injury mortality was observed throughout Europe, rates of mortality owing to both unintentional injuries and suicide varied widely among study countries at both the beginning and end of the study period. CONCLUSIONS: Whereas injury mortality rates in young people in most European countries are lower than in other parts of the world (including the United States), injuries represent a major public health problem in the European Union. The death toll from motor vehicle traffic crashes is a particular cause for concern.     

Home and leisure accidents in young persons under 25 years of age in the European Union: challenges for tomorrow

In all industrialised countries, the health status of children and adolescents has improved considerably. Today mortality in youngsters of one year and above is low, with the exception of mortality due to accidents: in childhood and adolescence, accidents (in particular those that occur at home or in leisure activities) represent the major cause of death. The objective of this paper is to assess the epidemiological evolution in the European Union in this respect and to review community actions aimed at reducing home and leisure accidents among youngsters living in the EU-region. Research underlines the multiple factors that bring about injuries caused by accidents and the role of environmental and behavioural factors in particular. The complexity and diversity of these factors suggest that priorities in prevention should be based on the severity of injuries and on the feasibility to prevent them. However, within the European Union, a consistent monitoring of mortality and morbidity related to home and leisure injuries is severely hampered by flaws in reporting current mortality and by the absence of a harmonized reporting system for morbidity. Launched in 1981, the European Home and Leisure Accident Surveillance System (EHLASS) is supposed to repair some of those deficiencies, but has not yet been in operation in all member states. Information from both systems is presented in this paper. Prevention policy itself requires coordination at various levels: between behavioural and environmental interventions and between various actors and intermediary groups involved. In the European Union a number of regulatory measures have been taken in order to improve of the safety of youngsters. However, only through clear-targeted programmes and well-coordinated structures and investments one can expect to achieve any change in injury among youngsters.     

Outcomes of a Falls Prevention Education Program Among Older Adults in Grenada

In Latin America and the Caribbean, there is a scarcity of data on falls, the leading cause of death as a result of unintentional injuries, among older adults aged 65+ years of age. By 2050, 80 % of the 2 billion older adults worldwide are expected to be living in this region; therefore, it is imperative that this issue receive urgent attention from community health practitioners, health educators and policy makers. Guided by Pillar 1—awareness of the WHO fall prevention model for community-dwelling older adults, the purpose of this paper was to describe the feasibility of implementing a falls prevention awareness educational initiative in the Eastern Caribbean Island of Grenada. Sixty-two older adults, average age 67, participated in a falls awareness workshop. An anonymous pre-workshop falls assessment checklist was distributed to establish baseline information followed by an interactive workshop. Eight fall risks were identified and 52 % of the participants reported a history of falls. Based on the group’s eagerness to participate, we are encouraged that falls prevention intervention initiatives are feasible among others of similar characteristics in Grenada and plan to implement Pillar II—objective falls assessment and Pillar III—on-going interventions.     

Fatal occupational injuries--United States, 1980-1997

CDC monitors deaths from occupational injuries through the National Traumatic Occupational Fatalities (NTOF) surveillance system (1,2). This report provides an overview of traumatic occupational deaths among civilian workers from NTOF from 1980 through 1997, the most recent year for which data are available. The data presented in this report indicate a decrease in occupational deaths overthis period with mining, agriculture/forestry/fishing, and construction having the highest death rates; motor-vehicle crashes were the leading cause of injury-related deaths for U.S. workers. State health departments and others involved in prevention of occupational injuries can use the data to prioritize intervention programs.     

Peer Reviewed: All-Cause Mortality in Tianjin,China, 1999-2004

Introduction

We analyzed trends of major causes of death in Tianjin, China, from 1999 through 2004 to better inform disease prevention and control programs and policies.

Methods

To report all-cause deaths among Tianjin residents from 1999 through 2004, we standardized mortality rates to the world population in 2000. We analyzed age, sex, and geographic distribution of deaths from different causes and the leading causes of death in Tianjin.

Results

The 5 leading causes of death in Tianjin were cardiovascular disease, cerebrovascular disease, malignant neoplasm, chronic lower respiratory disease, and injuries and poisoning. Mortality in Tianjin declined from 0.60% in 1999 to 0.48% in 2004. Noncommunicable diseases accounted for more than 80% of all deaths. Infant and maternal mortality in Tianjin were low. Life expectancy of Tianjin residents increased every year but was consistently longer in women. When deaths from the main chronic diseases are not considered, life expectancy lengthens substantially.

Conclusion

Chronic diseases are the leading cause of death in Tianjin, China. China should commit additional resources to supporting chronic disease prevention and control programs, including proven special health promotion projects.     

Child mortality in the developing countries of Africa

Infant mortality statistics in developing African countries are reviewed. According to the World Health Organization (WHO) surveys, there was an overall decrease in infant mortality from 1960-1986, although the infant mortality rate in the African region remains higher than in other WHO regions (119.4, compared with 40.6 in the European region, 11.8 in the Eastern Mediterranean region, 110.2 in the South- Eastern Asia, 49.7 in the American Region, and 44.5 in the Western part of the Pacific ocean). In infants younger than 28 days old, mortality is associated with pregnancy and labor complications, congenital birth defects, and birth trauma. In Algeria, Sierra Leone, Nigeria, Mozambique, Malawi, and Zimbabwe, 70-90% of all deaths were caused by tetanus (70-80% of African women give birth at home without any medical help). In a 1 month to 1 year old age group, the leading cause of mortality is diarrhea (52% in Sudan, 29.2% in Sierra Leone); other causes of death are measles (15.8%), acute respiratory diseases (14.3%), malaria (8.5%), and infectious meningitis (6%). In a 1-4 years old age group, leading cause of mortality is nutritional deficiencies (9%). In addition to medical causes, infant mortality is also associated with a number of socioeconomic factors: insufficient nutrition of mothers, heavy physical work during pregnancy, young age of mothers and short interval between pregnancies, lack of proper medical care during pregnancy and labor, and early switching to infant formula not following proper hygienic recommendations.     

Unintentional injury mortality in India, 2005: Nationally representative mortality survey of 1.1 million homes

ABSTRACT: BACKGROUND: Unintentional injuries are an important cause of death in India. However, no reliable nationally representative estimates of unintentional injury deaths are available. Thus, we examined unintentional injury deaths in a nationally representative mortality survey. METHODS: Trained field staff interviewed a living relative of those who had died during 2001-03. The verbal autopsy reports were sent to two of the130 trained physicians, who independently assigned an ICD-10 code to each death. Discrepancies were resolved through reconciliation and adjudication. Proportionate cause specific mortality was used to produce national unintentional injury mortality estimates based on United Nations population and death estimates. RESULTS: In 2005, unintentional injury caused 648 000 deaths (7% of all deaths; 58/100 000 population). Unintentional injury mortality rates were higher among males than females, and in rural versus urban areas. Road traffic injuries (185 000 deaths; 29% of all unintentional injury deaths), falls (160 000 deaths, 25%) and drowning (73 000 deaths, 11%) were the three leading causes of unintentional injury mortality, with fire-related injury causing 5% of these deaths. The highest unintentional mortality rates were in those aged 70 years or older (410/100 000). CONCLUSIONS: These direct estimates of unintentional injury deaths in India (0.6 million) are lower than WHO indirect estimates (0.8 million), but double the estimates which rely on police reports (0.3 million). Importantly, they revise upward the mortality due to falls, particularly in the elderly, and revise downward mortality due to fires. Ongoing monitoring of injury mortality will enable development of evidence based injury prevention programs.     

Trends in mortality from major diseases in Europe, 1980–1993

Trends in age-standardized death certification rates from all causes, coronary heart disease (CHD), cerebrovascular diseases, all neoplasms and lung cancer were analysed over the period 1980–1993 in 20 major European countries. There were steady and substantial declines of overall mortality in all western European countries for both sexes, although appreciable geographic differences persisted. These favourable trends reflect a decline in CHD mortality in most western countries, besides a persisting fall in cerebrovascular disease, and a substantial stability (with some decline in a few northern and central European countries) in cancer mortality. In contrast, in eastern European countries appreciable rises were registered in mortality from major causes of death considered for males. For females, only moderate declines were observed in Eastern Europe. In the early 1990s, overall mortality was 30 to 100% higher for males and 20 to 100% higher for females as compared to Western Europe. As indicated by the trends in lung cancer death rates, this reflects a major impact of the tobacco-related disease epidemic in subsequent cohorts, as well as more unfavourable lifestyle factors (i.e. aspects of diet, other environmental factors), and a delayed control of hypertension in Eastern Europe, together with a substantial excess of suicides, (road) accidents, homicides and alcohol-related diseases, and the delayed introduction of rational treatment for some conditions. An indication of reversal of mortality trends was evident in the early 1990s only in Poland. In conclusion, there is ample scope for intervention on avoidable mortality in eastern European countries.     

Global epidemiology of invasive meningococcal disease

Neisseria meningitidis is one of the leading causes of bacterial meningitis globally and can also cause sepsis, pneumonia, and other manifestations. In countries with high endemic rates, the disease burden places an immense strain on the public health system. The worldwide epidemiology of invasive meningococcal disease (IMD) varies markedly by region and over time. This review summarizes the burden of IMD in different countries and identifies the highest-incidence countries where routine preventive programs against Neisseria meningitidis would be most beneficial in providing protection. Available epidemiological data from the past 20 years in World Health Organization and European Centre for Disease Prevention and Control collections and published articles are included in this review, as well as direct communications with leading experts in the field. Countries were grouped into high-, moderate-, and low-incidence countries. The majority of countries in the high-incidence group are found in the African meningitis belt; many moderate-incidence countries are found in the European and African regions, and Australia, while low-incidence countries include many from Europe and the Americas. Priority countries for vaccine intervention are high- and moderate-incidence countries where vaccine-preventable serogroups predominate. Epidemiological data on burden of IMD are needed in countries where this is not known, particularly in South- East Asia and Eastern Mediterranean regions, so evidence-based decisions about the use of meningococcal vaccines can be made.     

Incidence and nature of farm-related injuries among children aged 6-15 during a 10-year period in one region in Poland

The health risks among children in "new" and "old" members of the European Union seem to be different. Farms are the most frequent place of injuries among children living in rural areas in Poland. Our aim is to present data on the farm-related injuries conditions among children aged 6-15 in one large region in Poland. The analysis has been made on the basis of information collected from the Farmers' Insurance Fund in W?oc?awek, which registers all farm-related injuries reported within the W?oc?awek Province. Over the 10-year study period 449 injuries were recorded (1.29 injuries per 1000 person-years). Among all victims there were 132 girls (29.4% of the total) and 317 boys. 14-year-old children fell victims of injuries most frequently (20.0% of all injuries). The highest number of injuries was recorded during the summer season. The injuries resulted mainly from falls or slips (47.2%) and falling from high altitudes (22.9% of all injuries). Individual and unattended works accounted for 37.5% of cases while 30.4% of all injuries happened while children were assisting in the work performed by adults. The sites were farm facilities (29.0%), farmyard (23.8%), around farm facilities (13.1%), pastures and meadows (11.1%), fields (9.1%), roads leading to houses or farm facilities (7.6%) and home (6.2%). We conclude that 13-15-year-old boys falling during an individual unattended work or while assisting in the work performed by adults, inside and around farm facilities, and during summer months, were the most frequent victims of injuries on farms. Information obtained in this study may be helpful in developing and implementing injury prevention strategies tailored to the Central-Eastern European agricultural realities.     

Public health and aging: nonfatal injuries among older adults treated in hospital emergency departments--United States, 2001

Because injuries generally are considered a problem of the young, injuries among older adults (i.e., persons aged > or =65 years) have received little attention. However, injuries are the eighth leading cause of death among older adults in the United States. In 2001, approximately 2.7 million older adults were treated for nonfatal injuries in hospital emergency departments (EDs); the majority of these injuries were the result of falls. To characterize nonfatal injuries among older adults, CDC analyzed data from the National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP). This report summarizes the results of that analysis, which indicate differences in type and mechanism of injury by sex, suggesting that prevention programs should be designed and tailored differently for men and women.     

On the road to prevention: road injury and health promotion

Road traffic injuries are already the leading cause of injury mortality and morbidity globally and by 2030 are predicted to be the fifth leading cause of mortality in the world. Australia has seen a dramatic reduction in road deaths and serious injuries since the 1970s and holds an international reputation for road traffic injury prevention due, in part, to its success in pioneering the multidisciplinary and intersectoral approach needed to address this significant issue and by applying an evidence‐led approach to policy development. The paper will discuss Australia's early success in road traffic injury prevention (road safety), particularly the achievements following the implementation of targeted programs that focussed on road user behaviours for which health promotion played a role. The most successful of these programs was the introduction of comprehensive seat belt laws, random breath testing and more recently, strategic speed enforcement programs. Amid an array of significant challenges faced by the transport system in the future, the rapid development in information and communication technologies applied to transport is likely to provide the next generation of road safety benefits. The potential for a semi‐autonomous transport system is likely to provide the next significant decline in road fatalities and serious injuries over the next 2 decades and the role of health promotion in relation to raising community engagement and building coalitions to increase uptake of new technologies will be discussed.     

The pattern of injury and poisoning in South East Iran

ABSTRACT: BACKGROUND: Injury is a leading cause of morbidity and mortality worldwide, and even more so in low and middle-income countries (LMICs). Iran is a LMIC and lacks information regarding injury for program and policy purposes. This study aimed to describe the incidence and patterns of injury in one province in South Eastern Iran. METHODS: A hospital-based, retrospective case review using a routinely collected registry in all Emergency Departments in Sistan and Baluchistan province, Iran for 12 months in 2007--2008. RESULTS: In total 18,155 injuries were recorded during the study period. The majority of injuries in South Eastern Iran were due to road traffic crashes. Individuals living in urban areas sustained more injuries compared to individuals from rural areas. Males typically experienced more injuries than females. Males were most likely to be injured in a street/alley or village whereas females were most likely to be injured in or around the home. In urban areas, road traffic related injuries were observed to affect older age groups more than younger age groups. Poisoning was most common in the youngest age group, 0 to 4 years. CONCLUSIONS: This study provides data on incidence and patterns of injury in South Eastern Iran. Knowledge of injury burden, such as this paper, is likely to help policy makers and planners with health service planning and injury prevention.