Delivering babies in a time of transition in Tula, Russia

OBJECTIVE: To investigate the provision of maternal services in the Tula region of Russia, with an emphasis on variations in practice. METHOD: The study was set in Tula Oblast. Data sources included an obstetric information database detailing all Tula deliveries in 2000 (n = 11,123) and structured interviews with the heads of maternity facilities and hospital maternity departments. RESULTS: Caesarean-section rates varied from 3.3-37%; episiotomy from 9-80%; and amniocentesis from 0-51%. As fertility rates fell since the 1980s, increasing numbers of women were hospitalized for 'pathological pregnancy' in an attempt to preserve infrastructure. CONCLUSION: Over-medicalization arises in a system typified by excess capacity and large numbers of specialists. Some practice variations were correlated with characteristics of mothers, but others derive from systems structures such as equipment availability. Improvements in practice will require addressing these structural elements and steering the clinical culture towards evidence-based medicine, rather than simply writing new decrees.     

浅谈俄罗斯的军事医学教育

俄罗斯的军事医学在历次战争中不断得到发展,形成了具有鲜明特色的军事医学理论和实践体系。本文对俄罗斯当前的军事医学教育进行了全面的描述和分析,认为其教育模式对我国的军事医学教育有着现实的借鉴意义。     

在俄罗斯运用针刺配合耳压戒烟53例

目的：观察针刺配合耳压疗法戒烟的疗效。方法：针刺取体穴：戒烟穴（桡骨茎突上方2横指）、神门、中脘、足三里、三阴交。耳穴主穴为：口、肺、神门，配穴为；肾上腺、胃、心、内分泌、气管、肝。每日1次，治疗6次为一疗程，4个疗程后统计疗效。结果：治愈36例，好转12例，无效5例。结论：针刺配合耳压对戒烟疗效可靠，但需要患者的积极配合，主观上有戒烟愿望，这样戒烟会更彻底，以免戒后复吸。     

Novel lyssaviruses isolated from bats in Russia

Two new rabies-related viruses were discovered in Russia during 2002. Viruses were isolated from bats in Eastern Siberia near Baikal Lake and in the western Caucasus Mountains. After preliminary antigenic and genetic characterization, we found that both viruses should be considered as new putative lyssavirus genotypes.     

High cardiovascular mortality in Russia cannot be explained by the classical risk factors. The Arkhangelsk study 2000

Since the beginning of the 1990s the public health situation in Russia has been characterized by an extremely high mortality and a significant reduction in life expectancy. Cardiovascular diseases remained the major cause of death. Only a few large population studies were conducted in Russia during this period. A total of 1968 men and 1737 women aged 18–75 years participated in a health survey in Arkhangelsk, Russia, over the period 1999–2000. Investigation included assessment of classic cardiovascular risk factors (family history, smoking, blood pressure, and blood lipids) along with general health variables. The paper presents sex specific data on risk factors for coronary heart disease. Though the cardiovascular mortality is high in Russia, the calculated risk for coronary heart disease (the Framingham risk score and the Norwegian risk score) was lower in all age groups of men and women in Arkhangelsk compared with studies from the Western Europe and USA. Our data suggest that high cardiovascular mortality in Russia may be driven not only by the classic risk factors for coronary heart disease.     

Environmental lead contamination in the Rudnaya Pristan--Dalnegorsk mining and smelter district,Russian far East

A preliminary survey of a remote mining and smelting region of the Russian Far East (RFE) indicates significant soil lead contamination and a high probability of childhood lead poisoning. Lead concentrations in residential gardens (476-4310 mg/kg, Gmean=1626 mg/kg) and in roadside soils (2020-22900 mg/kg, Gmean=4420 mg/kg) exceed USEPA guidance for remediation. Preliminary biokinetic estimates of mean blood levels suggest that preschool children are at significant risk of lead poisoning from soil/dust ingestion with levels predicted to average 13-27 microg/dl. Samples of other pathways, such as air, water, paint, interior dust, and garden produce, and pediatric and occupational blood lead levels are needed. An assessment of the industry's ability to improve emissions controls and materials handling should also be undertaken. Global lessons in remediating contamination problems and preventing childhood lead poisoning must be applied in innovative ways to meet the logistical, social, and economic challenges in the RFE.     

The development of market approaches in Russia

In the late 1980s, it became clear that poor outcomes of the Russian health system were caused not only by underfunding but also by inadequate management of health care. Some features of the system led to great inefficiency in medical care provision and an irrational structure of medical care. The recognition of this fact has intensified the search for new methods of finance and management. The underlying idea of health care reforms in Russia is to weaken providers' dominance, to make them more responsive to consumer preferences, and to change the structure of medical care. The main developments of the reform parallel the reforms in Western countries. These are primarily the separation of finance and provision of medical care, with the shift from an integrated to a contractual model of relationships between payers and providers. But the specific characteristics of the health care situation, primarily the great underfunding and the absolute dominance of state-owned medical facilities, make the reform in the Russian health sector more radical. This paper highlights the issues of the current and planned developments in the Russian health sector. After presenting the main characteristics of the current health systems, it addresses economic experiments which are underway in several regions of the new Russian Federation. They are designed to introduce elements of market relations into a highly bureaucratic system. The main features and the impact of the experiments are discussed. Then the new model of finance, which is based on a transition from tax-financed to the health insurance system, is presented.     

Temporal trends in the HIV-1 epidemic in Russia: predominance of subtype A

During the period 1996-1997, three highly homogeneous variants of HIV-1 were identified, circulating among injecting drug users (IDUs) in the former Soviet Union republics. One of these belonged to HIV-1 genetic subtype A (IDU-A), another belonged to HIV-1 genetic subtype B (IDU-B) and the third was a recombinant between the first two variants (CRF03_AB). However, since 1997, the HIV-1 epidemic has affected an increasing number of geographic regions in Russia. This study was undertaken to survey the prevailing genetic variants and to estimate the current proportions of these three HIV-1 genetic subtypes in Russia. Blood samples were taken in 1999-2003 from 1090 HIV-infected individuals and analysed by gag/env HMA. The IDU-A variant was found to be the majority variant (89.7-100%) in 44 of 45 regions of the Russian Federation studied. The IDU-A variant was also found to spreading rapidly through heterosexual transmission in 1999-2003 (30/34, 88%). CRF03_AB predominates in the Kaliningrad region only (28/29, 96.6%). The IDU-B variant is currently of minor importance in the IDU epidemic but other European subtype B variants predominate among men having sex with men (18/18, 100%). Sequence analysis of the env V3 encoding regions derived from HIV-1 infected individuals in Yekaterinburg (the main centre of the HIV-1 epidemic in Russia in 2002-2003) showed that the IDU-A variant is still highly homogeneous. The mean pairwise nucleotide distance (n = 9) was 2.89 +/- 1.14 (range 1.36-6.14). However, the mean genetic distance between each sequence within the samples collected from the Yekaterinburg IDU-A variant subset and the IDU-A consensus is 2.51 +/- 1.06 (range 1.36-4.66) and considerably higher than in South Russia in 1996 (0.79 +/- 0.51, range 0.38-1.90). The current HIV-1 epidemic in Russia is almost entirely caused by a highly homogeneous A-subtype strain, which will influence vaccine development strategies and must be taken into account in the quality control of molecular tests for the diagnosis of HIV-1.     

The Oral Health Status Among Residents of the Magadan Oblast, Russian Far East

In April 1991, an oral health situation analysis team comprising oral health professionals from the Alaska Area Native Health Service, the World Health Organization, and the Moscow Medical Stomatological Institute visited the Magadan region of the Soviet Far East at the request of the Ministries of Health of both the Russian Republic and the then-Soviet Union. As few oral health data had been available specific to the Magadan region, the purpose of the trip was to gather data concerning oral diseases epidemiology, demography, and health systems of the communities of Magadan, Seymchan, and Provideniya as the basis for recommendations and plan development. The data were collected using standard WHO methodology. The analysis team examined children in the age cohorts of 3–5, 6–7, 12, and 15 years. In addition, adults aged 35–44 and 65–74 years were examined in Magadan and Seymchan. Both caries and periodontal rates are high, with a rate of 4.3 DMFT among 12-year-olds in the total region, but up to 5.4 DMFT in one location. Specific findings and recommendations have been forwarded to local community and health officials. The project is ongoing, and plans are underway to provide continuing assistance in designing and implementing an effective program for the prevention and treatment of oral diseases.