Similar but different: health and economic crisis in 1990s Cuba and Russia

The collapse of the Soviet Bloc caused devastating economic crises in Cuba and in the Russian Federation but triggered remarkably different public health responses: while mortality rates in Russia increased substantially the crisis was barely visible in Cuban public health statistics. Fundamental social, political and cultural differences in the two countries and the respective specificities of the crisis in either country seem responsible, including different long-term health trajectories and different traditions of health-related agenda setting. Cuban policies combined traditional top down activism with grass root activities, strengthening social capital, while the "shock therapy" adopted in Russia had a corrosive effect on society, increasing psycho-social pressure and weakening support.     

Developing teaching skills for medical educators in Russia: a cross-cultural faculty development project

CONTEXT: Faculty development programmes have proved successful for improving teaching skills. We investigated whether or not a successful US-based faculty development programme for improving the teaching skills of medical faculty could be transported to Russia. METHODS: Five seminars, based on the 7 categories of the Stanford Faculty Development Program model, were presented to 48 teachers at Kazan State Medical University in Kazan, Russia. The seminars were comprised of mini-lectures, reviews of actual videotaped teaching scenario re-enactments, interactive role plays of teaching situations, and personalised goal setting for future teaching performance. Evaluation was performed through participants' self-reported ratings of teaching ability based on a retrospective pretest/post-test questionnaire and fulfilment of commitment of change (CTC) statements written by workshop participants. Outcomes were measured at both 1 and 12 months post-intervention. RESULTS: Survey response rates were 98% (47/48) at 1 month and 81% (39/48) at 12 months. Global teaching performance improved (pretest = 38.4, 1 month post-test = 43.7, 12 months post-test = 42.5; P < 0.001) as did ratings of specific teaching behaviours (pretest = 100.2, 1 month post-test = 121.3, 12 months post-test = 116.8; P < 0.001). A total of 127 CTC statements were made and 90 (71%) were successfully instituted. CONCLUSIONS: Our faculty development intervention demonstrated a positive, lasting effect on the teaching skills of Russian faculty members. This suggests that our efforts in transporting this intervention across the 2 cultures were successful.     

Alcohol poisoning in Russia and the countries in the European part of the former Soviet Union, 1970 2002

BACKGROUND: To investigate the phenomenon of alcohol poisoning in Russia and the countries in the European part of the former Soviet Union in the period 1970-2002. METHODS: Four time points were chosen spanning the late Soviet and post-Soviet periods. Data relating to alcohol poisoning deaths were collected at each point for the countries in the region-Belarus, Estonia, Latvia, Lithuania, Russia and Ukraine. Age-standardized death rates from alcohol poisoning were subsequently calculated for the total population and separately for men and women. RESULTS: In 1970, the alcohol poisoning rates in the countries in this region were exceptionally high in comparative terms. Rates continued to rise in the late Soviet period in all the countries, only falling in the period following Gorbachev's anti-alcohol campaign. Mortality from alcohol poisoning became more common amongst women during the study period. In post-Soviet society alcohol poisoning mortality is occurring on an unprecedented scale although there may be some divergence in trends between the Slavic and Baltic countries which had mirrored each other in the Soviet period. Extremely high poisoning rates are probably explained by a combination of the volume of alcohol being consumed, what exactly is drunk and how it is being drunk. The consumption of illicitly produced alcohol in the post-Soviet period may also be contributing to the high mortality rates. CONCLUSIONS: Acute alcohol poisoning has now reached unprecedented rates in parts of the ex-USSR with worrying trends among men as well as among women. Effective action by the governments concerned is now essential.     

Motivators and barriers to HIV testing among street-based female sex workers in St. Petersburg,Russia

Female sex workers are particularly susceptible to HIV-infection in Russia. However, a dearth of information exists on their utilisation of HIV services. A mixed-methods, cross-sectional study was conducted to examine motivators and barriers to HIV testing among street-based sex workers in St. Petersburg, Russia. The health belief model was the theoretical framework for the study. Twenty-nine sex workers participated in in-depth interviews, and 139 sex workers completed interviewer-administered surveys between February and September 2009. Barriers to getting an HIV test were fear of learning the results, worrying that other people would think they were sick, and the distance needed to travel to obtain services. Motivators for getting tested were protecting others from infection, wanting to know one's status and getting treatment if diagnosed. Logistic regression analysis demonstrated that knowing people living with HIV [aOR?=?6.75, 95% CI (1.11, 41.10)] and length of time since start of injection drug use [aOR?=?0.30, 95% CI (0.09, 0.97)] were significantly associated with recently getting tested. These results are important to consider when developing public health interventions to help female sex workers in Russia learn their HIV status and get linked to care and treatment services if needed.     

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.     

Risk factors for developing tuberculosis in remand prisons in St. Petersburg,Russia — a case-control study

Background Detainees have a substantial risk to develop tuberculosis (TB) due to a higher incidence of TB in remand prison compared to the civil community. They develop TB during incarceration not only due to poor living conditions in remand prison, but also due to some factors affecting their life before imprisonment. Prevention measures against TB spread from penitentiary institutions to society include study of factors, which contribute to TB development. Current study aims at identification of important risk factors of TB development in remand prison in St. Petersburg, Russia. Methods A retrospective matched case–control study was performed from May 2002 to May 2003 in two remand prisons in St. Petersburg. One hundred and fourteen prisoners (57 cases, 57 controls) were interviewed by using standardised questionnaire. Logistic regression analysis was performed to identify risk factors. Results Six factors were significantly linked to the risk of developing TB: narcotic drug use (odds ratio (OR): 2.6, 95% confidence interval (CI): 1.0–6.9), low income (OR: 3.2, CI: 1.2–8.6), high ratio of prisoners per available bed (OR: 4.0, CI: 1.1–15.0), not having own bed clothes (OR: 13.0, CI: 2.7–61.6), and little time outdoors (OR: 3.3, CI: 1.3–8.5). However, good housing before imprisonment (OR: 4.2, CI: 1.1–15.7) was a separate risk factor for TB. Conclusions Three of the risk factors (high number of prisoners per bed, not having own bed clothes, and little time outdoors) are certainly possible to approach by improvement of conditions in remand prisons. The remaining three factors (narcotic drug use, good housing before imprisonment, and low income) provide knowledge about study population, but cannot be intervened by prison’s medical staff.     

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.     

Hepatitis C virus infection among drug injectors in St Petersburg, Russia: social and molecular epidemiology of an endemic infection

Aims To understand the epidemiology and transmission patterns of hepatitis C virus (HCV), the predominant blood borne‐pathogen infecting injection drug users (IDUs), in a part of the former Soviet Union. Design Cross‐sectional respondent‐driven sample of IDUs. Setting St Petersburg, Russia. Participants A total of 387 IDUs were recruited in late 2005 and throughout 2006. Measurements Participants were surveyed to collect demographic, medical and both general and dyad‐specific drug injection and sexual behaviors. A blood sample was collected to detect antibodies to hepatitis C and to amplify viral RNA for molecular analysis. The molecular data, including genotypes, were analyzed spatially and linkage patterns were compared to the social linkages obtained by respondent‐driven sampling (RDS) for chains of respondents and among the injection dyads. Findings HCV infection was all but ubiquitous: 94.6% of IDUs were HCV‐seropositive. Among the 209 viral sequences amplified, genotype 3a predominated (n = 119, 56.9%), followed by 1b (n = 61, 29.2%) and 1a (n = 25, 11.9%). There was no significant clustering of genotypes spatially. Neither genotypes nor closely related sequences were clustered within RDS chains. Analysis of HCV sequences from dyads failed to find associations of genotype or sequence homology within pairs. Conclusions Genotyping reveals that there have been at least five unique introductions of HCV genotypes into the IDU community in St Petersburg. Analysis of prevalent infections does not appear to correlate with the social networks of IDUs, suggesting that simple approaches to link these networks to prevalent infections, rather than incident transmission, will not prove meaningful. On a more positive note, the majority of IDUs are infected with 3a genotype that is associated with sustained virological response to antiviral therapy.