Chronic disease prevalence in immigrants to Israel from the former USSR

The purpose of this study was to evaluate the prevalence of chronic health conditions in the Russian population who immigrated to Israel during 1989–1992. Interviewer-supported self-administered questionnaires were distributed to a 50% random sample of 1710 immigrants residing in the city of Nazareth-Ilit in Northern Israel. The final study group included 897 adults after a 3.5% of noncompliance. The study participants were asked to report all chronic diseases from a list of 11 disease states. The data were coupled with their demographic data and are presented as age/sex-specific prevalence rates. Self-reported disease prevalence rates among the Russian immigrants to Israel were found to be very high (62.2% of the males and 68.7% of the females reported a mean 3–3.5 diseases per person). These reported rates were significantly higher for immigrants from the European republics (67.1%) than for those from Asian republics (55.6%). The highest reported age-specific disease prevalence rates were for musculoskeletal diseases (389/1000), ischemic heart disease (340/1000), gastrointestinal diseases (269/1000), and hypertension (226/1000). A higher rate among females was found for almost all disease states. The prevalence rates reported by the Russian Jews in this study are much higher than commonly observed in Western countries. This is in accordance with a similar difference in reported mortality rates between Western countries and the former USSR. The etiologic explanation of this finding is yet to be studied. In addition, and in light of the mass immigration of Eastern European residents to the West it is of major importance for local health authorities to respond appropriately to the differences in health status of these immigrating populations.     

Health care reform in Russia: a survey of head doctors and insurance administrators

In keeping with the introduction of market-oriented reforms since the collapse of the Soviet Union, Russia's health care system has undergone a series of sweeping changes since 1992. These reforms, intended to overhaul socialized methods of health care financing and delivery and to replace them with a structure of competitive incentives to improve efficiency and quality of care, have met with mixed levels of implementation and results. This article probes some of the sources of support for and resistance to change in Russia's system of health care financing and delivery. It does so through a national survey of two key groups of participants in that system: head doctors in Russian clinics and hospitals, and the heads of the regional-level quasi-governmental medical insurance Funds. The survey results demonstrate that, on the whole, both head doctors and health insurance Fund directors claim to support the recent health care system reforms, although the latter's support is consistently statistically significantly stronger than that of the former. In addition, the insurance Fund directors' responses to the survey questions tend consistently to fall in the shape of a standard bell curve around the average responses, with a small number of respondents more in agreement with the survey statements than average, and a similarly small number of respondents less so. By contrast, the head doctors, along a wide variety of reform measures, split into two camps: one that strongly favors the marketization of health care, and one that would prefer a return to Soviet-style socialized medicine. The survey results show remarkable national consistency, with no variance according to the respondents' geographic location, regional population levels or other demographic or health characteristics, age of respondents, or size of health facility represented. These findings demonstrate the emergence of well-defined bureaucratic and political constituencies, their composition mixed depending on the particular element of reform under discussion, for and against specific avenues of continuity and change in Russia's health policy. As Russia struggles to devise policy strategies and tactics that balance access, equity, quality, and efficiency, it confronts not only policy choices but also political challenges that look not dissimilar to those faced by health reformers elsewhere in the world.     

Alcohol-related human losses in Russia in the 1980s and 1990s

ABSTRACT Aims The estimation of alcohol‐related human losses in Russia in the 1980s and 1990s. Design The estimation was made by comparing changes in the total number of deaths and in specific categories, and alcohol consumption in Russia during this time. Setting The anti‐alcohol campaign, launched in 1985, and the market reforms launched in 1992 were associated with large and rapid changes of alcohol ­consumption in Russia. Findings In the early 1980s, the aggregate number of direct and indirect alcohol‐related life losses was more than 500 000 per annum, or 32% of total deaths. Half of the alcohol‐related human losses in Russia over the period studied were due to accidents, poisoning and violence. Following the anti‐alcohol campaign and reduction in annual per capita alcohol consumption from 14.2 (1984) to 10.5 l (1986), mortality decreased from 1161.6 to 1054.0 per 100 000 of the population. It is estimated that from 1986 to 1991 the lives of 1.22 million people were spared; that is, 11.4% of the number of deaths expected without the anti‐alcohol campaign. All categories of deaths were reduced with the exception of neoplasms, infectious and parasitic diseases. In the period of the so‐called market reforms both alcohol consumption and mortality increased sharply. The total number of alcohol‐related deaths for 1994 was 751 000 in the population, or 33% of all deaths (direct and indirect losses). In 1995 alcohol consumption started to decrease. A decrease in mortality was registered despite the sharp deterioration of the quality of life in the country. However, a new growth of total mortality, fatal alcohol poisonings and number of alcohol psychoses began in 1999–2000. Conclusion The results of this study show the enormous scale of alcohol‐related mortality in Russia. It has been revealed that alcohol‐related deaths are at the top of the hierarchy of all premature deaths in the country. Decreasing alcohol consumption is an important means of decreasing total mortality in Russia.     

Seasonal variation and hospital utilization for tuberculosis in Russia: hospitals as social care institutions

BACKGROUND: Clinical management of tuberculosis in Russia involves lengthy hospitalizations, in contrast to the recommended strategy advocated by the World Health Organization. METHODS: We used Fourier transform, spectral analysis and Student's t-test to analyse periodic and seasonal variations in admission and discharge rates for tuberculosis hospitalizations in 1999-2002, using routinely captured data from the Samara Region, Russia. RESULTS: Hospital admissions in colder months were significantly higher than in warmer months. The mean monthly adjusted number of admissions in colder and warmer months for all adults was 413 and 372 (P < 0.01), for unemployed adults 218 and 198 (P < 0.02) and for pensioners 104 and 82 (P < 0.05). Hospital discharges varied seasonally. Maximum differences between admissions and discharges occurred in colder months and minimum differences were observed in warmer months. CONCLUSIONS: As hospitalizations of tuberculosis patients in colder months fulfil an important social need, shifts to ambulatory care must be carefully managed.     

Atopy in Norwegian and Russian adults: a population-based study from the common border area

Background: Several studies have concluded that atopy is more common in Western than in Eastern Europe. We aimed to study whether a similar difference exists between Norwegian and Russian adults living in geographically adjacent areas. Methods: A cross‐sectional population‐based study was performed in Sør‐ Varanger municipality (Norway) and in the cities of Nikel and Zapolyarny (Russia). The Russian cities are heavily polluted by sulfur dioxide from local nickel industry. In addition to questionnaire information, results on IgE sensitization (S‐Phadiatop, Pharmacia & Upjohn, Uppsala, Sweden) were obtained from 3134 Norwegian and 709 Russian participants. Results: A positive Phadiatop was found in 20.7% of the Norwegians (men 21.9%, women 19.7%) and in 27.5% of the Russians (men 35.7%, women 23.0%); the sex‐ and age‐adjusted relative risk of testing positive in Russia being 1.49 (95% CI 1.23–1.81). The Norwegian participants reported more atopic dermatitis and hay fever, although this difference was statistically significant only for atopic dermatitis in women. Conclusion: IgE sensitization was more common in Russia than in Norway, unlike findings from other east–west European studies. The Russians did not, however, report more atopic diseases. This discrepancy might reflect different awareness of allergies in the two countries and demonstrates the need for objective markers of atopy when comparing prevalence in different populations.     

Self-reported health in the Republic of Karelia, Russia and in north Karelia, Finland in 1992

BACKGROUND: Major differences in mortality, cardiovascular disease risk factors and health behaviour are known to exist between the populations of eastern Finland and the Republic of Karelia, Russia. Little is known, however, whether similar differences exist in subjective health. METHODS: In spring 1992 a population survey was conducted in North Karelia, Finland and in the area of Pitk?ranta, Republic of Karelia, Russia. Random population samples (n = 2,000 in North Karelia and n = 1,000 in Pitk?ranta) stratified for age and sex were taken from the population registers. The subjects completed questionnaires and were examined at local health centres. RESULTS: In North Karelia 50% of men reported their health as being quite good or very good, compared to 34% in Pitk?ranta (p < 0.0001 for area difference). Among women the corresponding percentages were 58% in North Karelia and 22% in Pitk?ranta (p < 0.0001). High household income and education were associated with good self-rated health among both sexes in North Karelia and among women but not men in Pitk?ranta. Self-reported physical condition was better in North Karelia than in Pitk?ranta (p < 0.0001). Psychosomatic symptoms (p = 0.0002 among men and p < 0.0001 among women) and many somatic symptoms were more prevalent in Pitk?ranta than in North Karelia. CONCLUSION: In general, people in North Karelia, Finland feel healthier than people in the neighbouring Republic of Karelia, Russia. Socioeconomic differences in subjective health are less prominent in the Republic of Karelia.     

Fluctuations in male ischaemic heart disease mortality in Russia 1959–1998: Assessing the importance of alcohol

Introduction and Aims. The decline in cardiovascular mortality in Russia following the Soviet anti‐alcohol campaign of 1985–1988 and the subsequent increase when these extreme alcohol controls were repealed suggested that alcohol consumption is responsible for a substantial number of ischaemic heart disease (IHD) deaths in Russia. To examine whether a similar conclusion can be drawn on the basis of a time‐series analysis covering a longer time period, namely 1959–1998. Design and Methods. Using ARIMA time‐series analysis, the male IHD mortality rates from 1959 to 1998 were analysed in relation to three indicators of alcohol consumption: estimated per capita consumption, mortality from liver cirrhosis and alcohol poisonings. Cigarette sales and lung cancer mortality were used as indicators of smoking. Results. Each indicator of alcohol consumption had positive and statistically significant relationships with male IHD mortality in bivariate autoregressive integrated moving average models. The association was stronger in models predicting changes in premature male IHD mortality (30–54 years). At least one alcohol indicator was significantly related to IHD mortality in multivariate models, and in the case of premature IHD mortality, both mortality indicators were significant. Discussion and Conclusions. The results provide additional empirical evidence supporting alcohol's conceivable negative effects on IHD in Russia and the idea that binge drinking could be the mechanism through which this effect is mediated. There were no signs of any protective effects from alcohol among Russian men.[Ramstedt M. Fluctuations in male ischaemic heart disease mortality in Russia 1959–1998: Assessing the importance of alcohol. Drug Alcohol Rev 2009;28:390–395]     

Developmental Pathway Modeling in Considering Behavior Problems in Young Russian Children

In planning interventions it is essential to understand how adverse risk factors in early childhood are associated with child mental health problems, whether some types of problems can be better explained by the specific risk factors, and whether early risk factors are differently related to different types of child behavior problems. A community sample of 692 1.5–3.5-year-old children from Northern Russia was assessed by means of maternal reports. The study compared two models for the development of internalizing (withdrawn, anxious/depressed) and externalizing (aggressive, destructive) behavior problems in relation to the same early risk factors using structural equation modeling. Findings suggested that the development of these problems is related to maternal psychological problems and alcohol use during pregnancy, and mediated by the continuing maternal and family dysfunction and compromised postnatal condition of the child. Results indicated good model fit for both internalizing and externalizing problems, and neither of the models fit significantly better than the other. Findings are discussed in terms of understanding developmental risk and informing intervention and prevention efforts.