Decentralization of the DOTS programme within a Russian penitentiary system. How to ensure the continuity of tuberculosis treatment in pre-trial detention centres

BACKGROUND: In Kemerovo region (Siberia), three pre-trial detention centres (SIZO; Ministry of Justice) serve as the gateway to the penitentiary system, comprised of 23 prisons and 30,000 detainees. The follow-up for tuberculosis (TB) patients released into civil society is unreliable. Due to varying detention times and frequent transfers to temporary detention centres (IVS; Ministry of Internal Affairs) for investigation and trial, and concerns about continuity of treatment, SIZOs were not included in the revised TB control programme initiated during 1996. METHODS: To investigate the feasibility of DOTS (Directly Observed Therapy, Short-Course) expansion into SIZOs, general detainee release was studied by examining 10% of files from detainees admitted during 1998 (SIZOs 1,2,3). Then, 5% of general files from SIZO 1 were examined to determine SIZO-IVS flow; 224 TB patient files from SIZO 3 were evaluated to determine the pattern of release/transfer. RESULTS: TB patients in SIZO 3 have less chance of release before six months of detention than non-TB detainees (14/224, 6.3% versus 774/2276, 34%; p < 0.001). Among detainees not released, 60% are not moved during the first six months of detention. For those who move, the mean stay in IVS was 9.5 (+/- 6) days. The incidence of active disease detected upon entry to SIZO 3 was 4,560/100,000, the subsequent rate during the same year of detention 880/100,000. CONCLUSION: Despite frequent detainee movements between institutions, DOTS should be introduced into the earliest stages of detention to prevent case mismanagement, and links to the civilian programme should be developed.     

中医药在俄罗斯

1中医药在俄罗斯历史悠久,基础深厚 俄罗斯与前苏联各加盟共和国了解中医和针灸早于欧洲其它国家.大约公元10世纪(北宋年间),中药与针灸就通过民间交往和国家贸易途径传入俄罗斯.到了明代(公元1368～1644年),中俄接触日益增多,针灸已为俄国人所使用.在中俄边境附近的居民也开始使用中草药.公元1689年,中俄尼布楚条约签订之后,俄国医学使团在来华学习牛痘接种技术(当时欧洲天花流行)的同时也考察了中国的针灸术.此后,俄国医学界开始关注针灸与中医.公元1773年,俄国的列比奥欣研究并报道了草药的收藏与应用.其中,不少品种是中药.     

HLA profile of three ethnic groups living in the North-Western region of Russia

HLA class II alleles were determined by PCR-SSO and PCR-SSP typing of DNA samples from 55 Nentsy, 81 Saami and 73 Pomor individuals from the North-European part of Russia. The results were compared with similar data from Russians. A high frequency of the DRB1*04-DQA1*0301-DQB1*0302 haplotype and a low frequency of the DRB1*11-DQA1*0501-DQB1*0301 haplotype, observed in all three ethnic groups, may indicate a common aboriginal component in their ancestry. Saami and Pomors displayed a similar pattern of allele and haplotype distribution, with the exception of the DRB1*04-DQA1*0304-DQB1*0301 haplotype, which was significantly higher among Saami compared Nentsy, Pomors and Russians. Nentsy individuals had a particularly high frequency of the DRB1*09-DQA1*0301-DQB1*0303 and the DRB1*12-DQA1*0501-DQB1*0301 haplotypes. Genetic distances and correspondence analysis show that Pomors have a close relationship with Norwegians and Finns, whereas Nentsy and Saami are more closely related to Oriental populations.     

Molecular epidemiology of Kaposi's sarcoma-associated herpesvirus/human herpesvirus 8 strains from Russian patients with classic, posttransplant, and AIDS-associated Kaposi's sarcoma

We report the molecular characterization of 38 new Kaposi's sarcoma-associated herpesvirus (KSHV) strains from Russian patients with either classic (25 cases), epidemic/AIDS-associated (7 cases), or posttransplant/immunosuppressed patients (6 cases), or Kaposi's sarcoma (KS). While a complete sequence of the K1 gene (870 bp) was obtained from 30 strains, only partial sequences of the hypervariable regions VR1 (372 bp) and/or VR2 (381 bp) of the K1 gene were obtained from eight strains of KS paraffin blocks. Sequence comparison and phylogenetic studies indicate that the novel KSHV strains belong to either the A subtype (28 cases) or the C subtype (10 cases). Within the 28 strains of A subtype, 24 (86%) belong to the large A' subgroup, mostly A1 and A1' clades, and 4 belong to the A" subgroup, mostly A3 clade. Within the 10 strains of subtype C, 4 were of C' subgroup, and 6 of the C". Some molecular variants of subtype A' were observed, with 3 strains exhibiting an insertion of a single amino acid at the position 65 and 2 strains (both from AIDS-KS) with an unique deletion of 17 amino acids in the VR2 region. Polymerase chain reaction-based subtyping of the K14.1 genomic region indicated that most (23/32) of the novel strains belonged to the P subtype. The results indicate that despite a wide genetic diversity of A and C K1 subtypes of KSHV strains present in Russia, most are closely related and belong to the A1 or A1' molecular clades suggesting a common origin. This study also expands the data regarding the absence of any correlation between a K1 molecular subtype and a specific KS type (classic, epidemic, or posttransplant), as well as between the K1 and K14.1 molecular subtypes.     

Characteristics of pathogenic Neisseria meningitidis in Moscow: prevalence of 'non-European' strains

Objective: To investigate the distribution of serogroups, serotypes and subtypes, and susceptibility to antibiotics, of 75 strains isolated from patients with systemic meningococcal disease in Moscow in 1993–95.
Results: In contrast to the situation in most European countries, 21% of group A strains were found. Sixty-nine per cent of the strains were non-serotypeable. using the current panel of antibodies, and 21% of strains were non-subtypeable. Twenty-nine different serotype-subtype combinations were found among 69 strains of group A, B and C. No combination predominated clearly; relatively more frequent strains had the formulae B:NT:P1.2, A:4:P1.5,10 and C:4:P1.10. Recently, such strains have been very rare in western Europe; in contrast, the strains predominating in western Europe were not found in Moscow. All strains were sensitive to penicillin, chloramphenicol and rifampicin.
Conclusions: Moscow strains of Neisseria meningitidis demonstrated a substantial diversity of serotypes and subtypes that probably corresponded to a post-epidemic situation in Russia. The obvious difference in circulating strains and presumably in immunity of populations in western Europe and Russia increases the probability of mutual exchange of pathogenic strains and stresses the need for group B vaccine protecting from both western and eastern European variants of meningococci.     

Herbal and food folk medicines of the Russlanddeutschen living in Künzelsau/Taläcker, South-Western Germany

An urban ethnobotanical study was carried out among a community of Russlanddeutschen (Germans from Russia) who in recent years have moved from Russia and Central Asia to Künzelsau, a small town located in Württemberg, in South-Western Germany. Thirty-six in-depth interviews were conducted with the women in this community, and 62 homemade medicinal preparations derived from 46 botanical species were recorded. As well as common medicinal plant uses that are well known in modern evidence-based German and Western European phytotherapy, we were able to record traces of the community's Russian and Central Asian (Turkic) heritage through the very popular use of sorrel as a depurative or for preventing and treating colds and flu; the use of dill as a digestive; watermelon as a diuretic; birch to relieve rheumatism and arthritis; buckwheat as a tonic; rye-based fermented beverages as a stimulant and as a depurative, diverse berries to prevent colds and flu; coriander as a digestive, and other medicinal foods. Traces of archaic German preparations were also recorded, which were probably Swabian in origin. Nearly half of the overall quoted items represented folk functional foods. The researchers believe that the findings in this study could stimulate public health policies aimed at improving both the phyto-pharmacovigilance of lesser-known herbal drugs, and the health and well-being of migrants by promoting a better understanding of emic health beliefs and newcomers' healing strategies.     

Transition to Home: Family Perspectives on Care in Russia

Our world is shrinking because of computerized linkages and the mobility of society. Information is shared rapidly around the world. Issues surrounding newborn and infant nursing are global. In efforts to acknowledge the international community, each Newborn and Infant Nursing Review (NAINR) issue will feature a column that highlights care-related issues from a featured country or region of the world. This article focuses on Russia. Newborn and infant health issues are global ones. To review issues occurring in different areas of the world, different areas of the globe that address NAINR's theme-oriented topic will be featured. This month, Hospital No. 1 in Saint Petersburg, Russia, will be featured. Our guest author is Marina Boykova, RN.     

Japan-Russia Pediatric Society

In March 1990, medical interchange between Japan and the Soviet Union began with a letter from the local health bureau of Khabarovsk. We visited Khabarovsk three times and Kamchatka once, and saw many hospitals and patients. Russian doctors of pediatrics visited Japan. Medical information was exchanged and discussed. The Japan-Russia Pediatric Society was established to perform interchange of medical information, technology and staff such as doctors, nurses and technicians between Japan and Russia, especially the Far East district of Russia. The Society meeting has been held three times: Tokyo (1991), Khabarovsk (1992) and Niigata (1993). It is necessary to continue the interchange between the two countries.     

Cancer mortality among Moscow shoe workers exposed to chloroprene (Russia)

Objectives: To assess the risk of cancer among workers of a Moscow (Russia) shoe factory exposed to chloroprene (2-chloro-1,3-butadiene) (CP).Methods: This is a retrospective cohort mortality study among 5,185 shoe manufacturing workers employed between 1940 and 1976, and followed from 1979 through 1993. Exposure to CP was assessed by linking the job history with industrial hygiene data. We calculated standardized mortality ratios (SMR) using the Moscow population as reference, and conducted an internal comparison analysis based on Poisson regression modeling.Results: For the entire cohort, all-cause mortality was close to expectation and all-cancer mortality was increased. There was an increase in the mortality from liver cancer (SMR=2.4, 95 percent confidence interval [CI]=1.1-4.3), kidney cancer (SMR=1.8, CI=0.9-3.4), and leukemia (SMR=1.9, CI=1.0-3.3). Mortality from liver cancer and leukemia was associated with various indicators of CP exposure. A similar, although less consistent, pattern was found for kidney cancer mortality; while for the remaining neoplasms, no association was suggested with CP exposure.Conclusions: The association between CP exposure and risk of leukemia may be due to concomitant exposure to benzene. The results for liver cancer point towards a carcinogenic effect of CP.     

The decision to perform Caesarean section in Russia.

BACKGROUND: Clinical practice in Russia is set out in a series of centralized guidelines. However, many of these guidelines are not supported by evidence and, despite their existence, there is considerable unexplained variation in practice. This study examines the decision to recommend a Caesarean section, an intervention for which there is a solid evidence base, but whose use varies considerably among facilities in Russia. AIM: To identify the factors that Russian obstetricians take into account when recommending a Caesarean section. METHODS: Conjoint analysis. Ninety-two obstetricians from three regions were asked to state whether they would recommend a Caesarean section in each of 30 vignettes (including three for validation) combining 10 medical, social and organizational factors previously identified as contributing to the decision to intervene, including some absolute indications to intervene or not to, on the basis of international evidence. RESULTS: Checks for consistency within ratings by individuals gave no cause for concern. However, there was a wide variation in the probability of intervening among obstetricians, with six recommending intervention in only one scenario and one in 27 scenarios. Some factors were consistent with evidence but others were not, such as myopia or previous abortions. INTERVENTION: was more likely at 11 p.m. than at noon. Male obstetricians were more likely to intervene than females. CONCLUSION: This study highlights the importance of understanding clinical decision-making in Russia as a prelude to changing it.