Did the Taliban's Opium Eradication Campaign Cause a Decline in HIV Infections in Russia?

We offer a new hypothesis for why HIV infections fell rapidly after 2001 in Russia: the Taliban's opium eradication campaign in Afghanistan reduced the supply of heroin, causing use to fall and, thus, transmission of HIV to fall. We present evidence of the impact of the eradication campaign on the heroin market and show that the fall in HIV infections happened simultaneously in Russia and surrounding countries soon after the eradication campaign. We also show that the decline in HIV infections only occurred in injecting drug users, while other risk groups were unaffected. Limitations to our analysis are discussed.     

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.     

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.     

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.     

HIV/AIDS Knowledge and Attitudes of STD Clinic Attendees in St. Petersburg, Russia

Over the last several years, Russia has experienced dramatic increases in rates of HIV and other sexually transmitted disease (STDs). This study examined HIV/AIDS knowledge, attitudes toward condoms, and sources of information about HIV in a sample of 200 male and 200 female Russian STD clinic patients. Study participants displayed substantial knowledge deficits concerning AIDS and HIV transmission. Superior knowledge was associated with younger age, greater education, positive attitudes toward condoms, having more sources of information about HIV/AIDS, and believing that the government is telling the truth about AIDS. More-positive attitudes toward condoms were associated with having a larger number of information sources, greater HIV/AIDS knowledge, and not being in a steady relationship. Many participants reported not trusting government and media sources of information concerning AIDS. Participants also reported concerns regarding the low quality and high cost of condoms in Russia. Results of the study suggest that interventions designed to increase knowledge and awareness of AIDS among Russians at high risk for HIV are urgently needed.     

俄罗斯马业经济现状及发展趋势

俄罗斯是世界上马业经济比较发达的国家之一,培育出很多优秀马匹品种,在世界养马史上做出了卓越的贡献。根据2011年数据,俄罗斯马匹保有量为136万多匹。在市场经济背景下,俄罗斯马业经济呈现多元化发展趋势,运动用马、产品用马、工作用马、繁育用马结构较为合理。建立了较为完善管理机构,制定了标准的马匹登记、质量评价及马匹饲养、繁育、调教全过程财政补贴体系,依据马业中长期发展规划加强马业经济软硬件设施建设。     

Understanding the role of physicians within the managerial structure of Russian hospitals

This article examines the role of physicians within the managerial structure of Russian hospitals. A comparative qualitative methodology with a structured assessment framework is used to conduct case studies that allow for international comparison. The research is exploratory in nature and comprises 63 individual interviews and 49 focus groups with key informants in 15 hospitals, complemented by document analysis. The material was collected between February and April 2017 in five different regions of the Russian Federation. The results reveal three major problems of hospital management in the Russian Federation. First, hospitals exhibit a leaky system of coordination with a lack of structures for horizontal exchange of information within the hospitals (meso-level). Second, at the macro-level, the governance system includes implementation gaps, lacking mechanisms for coordination between hospitals that may reinforce existing inequalities in service provision. Third, there is little evidence of a learning culture, and consequently, a risk that the same mistakes could be made repeatedly. We argue for a new approach to governing hospitals that can guide implementation of structures and processes that allow systematic and coherent coordination within and among Russian hospitals, based on modern approaches to accountability and organisational learning.     

The composition of surrogate alcohols consumed in Russia

BACKGROUND: In the course of a case-control study examining determinants of premature death among working age men, it became clear that a significant percentage of the population (7.3%) were drinking a variety of surrogate alcohol products (products not legally sold for consumption). In this population, where there is a high death rate from alcohol-related causes, including acute alcohol poisoning, it was important to know what these products contained. METHODS: The identity of products being consumed was identified from the survey of controls. Representative samples were obtained and subjected to analysis using gas chromatography and mass spectrometry to determine their composition. RESULTS: Three broad groups of product were identified: samogon (home-produced spirits); medicinal compounds; and other spirits (mainly sold as aftershaves). Commercially produced vodkas were used for comparison. Samogon contained lower quantities of ethanol than vodka [mean, 39 vs. 44 volumetric percentage (v/v%), respectively] but in addition contained certain toxic long-chain alcohols. Medicinal compounds contained only ethanol, at a higher concentration that vodka (mean, 66 v/v%), while the other spirits, which were also essentially pure ethanol, contained a mean of 94 v/v%. CONCLUSIONS: A significant number of Russian men are drinking products that have either very high concentrations of ethanol or contaminants known to be toxic. These products are untaxed and thus much less expensive than vodka. There is an urgent need for policy responses that target their production and consumption.