This paper reviews Russia's health crisis, financing, and organization and public health reform needs.
The structure, policy, supply of services, and health status indicators of Russia's health system are examined.
Longevity is declining; mortality rates from cardiovascular diseases and trauma are high and rising; maternal and infant mortality are high. Vaccine-preventable diseases have reappeared in epidemic form. Nutrition status is problematic.
The crisis relates to Russia's economic transition, but it also goes deep into the former Soviet health system. The epidemiologic transition from a predominance of infectious to noninfectious diseases was addressed by increasing the quantity of services. The health system lacked mechanisms for epidemiologic or economic analysis and accountability to the public. Policy and funding favored hospitals over ambulatory care and individual routine checkups over community-oriented preventive approaches. Reform since 1991 has centered on national health insurance and decentralized management of services. A national health strategy to address fundamental public health problems is recommended.
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The article analyzes results of treatment of 900 thousands patients with acute surgical diseases of organs of the abdominal cavity. Factors responsible for unfavorable results are shown. The authors consider that reduced lethality depends on strict observation of the main principle of the medical doctrine in emergency surgery and on wider introduction of endovideosurgical technologies into practice.
A comparative analysis has been carried out of indices for health status in 137,072 persons who took part in the elimination of the aftermath of the Chernobyl accident, using records of the National Register of Ukraine. The above-mentioned indices were for time-related general morbidity, mortality, disability during the period of 1988-1996. There has been revealed yearly increase in morbidity rates in all classes of diseases, in particular those of the circulatory system, nervous system, and sense organs, digestive, and respiratory systems. High morbidity rates are recordable with respect to that class of diseases afflicting the endocrine system, blood, and hemopoietic organs, neoplasms including malignant tumours. The disability rates tended to increase above average statistical ones for Ukraine.
Cancer mortality and morbidity rates were studied in the population residing in 2 areas adjacent to thermoelectric stations and in 3 areas next to atomic power stations. They were shown to be higher in the population living in vicinity of the former than in the latter stations.
THE THEME: assessment of the influence of socio-economic factors on health and demographic indicators.
population of municipalities of the Voronezh region.
the justification of the system of measures aimed at stabilizing the medical-demographic situation at the regional level.
methods of Health Statistics; questionnaire.
the low socio-economic status of the population is set in the territories, depressed at the level of demographic development. The contribution of socio-economic indicators in health and demographic situation has been determined Reliable cause-effect relationships between health and demographic indicators and the level of socio-economic development of the population have been identified.
Commissioned by the International Epidemiological Association, this article is part of a series on burden of disease, health indicators and the challenges faced by epidemiologists in bringing their discoveries to provide equitable benefit to the populations in their regions and globally. This report covers the health status and epidemiological capacity in the North American region (USA and Canada).
We assessed data from country-specific sources to identify health priorities and areas of greatest need for modifiable risk factors. We examined inequalities in health as a function of social deprivation. We also reviewed information on epidemiological capacity building and scientific contributions by epidemiologists in the region.
The USA and Canada enjoy technologically advanced healthcare systems that, in principle, prioritize preventive services. Both countries experience a life expectancy at birth that is higher than the global mean. Health indicator measures are consistently worse in the USA than in Canada for many outcomes, although typically by only marginal amounts. Socio-economic and racial/ethnic disparities in indicators exist for many diseases and risk factors in the USA. To a lesser extent, these social inequalities also exist in Canada, particularly among the Aboriginal populations. Epidemiology is a well-established discipline in the region, with many degree-granting schools, societies and job opportunities in the public and private sectors. North American epidemiologists have made important contributions in disease control and prevention and provide nearly a third of the global scientific output via published papers.
Critical challenges for North American epidemiologists include social determinants of disease distribution and the underlying inequalities in access to and benefit from preventive services and healthcare, particularly in the USA. The gains in life expectancy also underscore the need for research on health promotion and prevention of disease and disability in older adults. The diversity in epidemiological subspecialties poses new challenges in training and accreditation and has occurred in parallel with a decrease in research funding.
Many studies have shown that depression contributes to a higher risk of developing cardiovascular disease (CVD). Use of antidepressants and its association with CVD development has also been investigated previously but the results have been conflicting. Further, depression and use of antidepressants have been more widely studied in relation to coronary heart disease rather than stroke. A population-based cohort study consisting of 36,654 Swedish elderly twins was conducted with a follow-up of maximum 4 years. Information on exposures, outcomes and covariates were collected from the Swedish national patient registers, the Swedish prescribed drug registry and the Swedish twin registry. Depression and antidepressant use were both associated with CVD development. The risk was most pronounced among depressed patients who did not use antidepressants (HR 1. 48, CI 1.10-2.00). When assessing the two main CVD outcomes coronary heart disease and ischemic stroke separately, the predominant association was found for ischemic stroke while it was absent for coronary heart disease. The association between depression and stroke also remained significant when restricting to depression diagnoses occurring at least 10 years before baseline. The study supports that depression is a possible risk factor for development of CVD. Moreover, the hazard rate for CVD outcomes was highest among depressed patients who had not used antidepressants. The association with clinical depression is more marked in relation to stroke and disappears in relation to development of coronary heart disease.