The trends in development of aortic and coronary atherosclerosis in healthy male population were studied by WHO methods in three trials: in 1963-1965, 1985-1987, 2001-2003. It was found that atherosclerosis and coronary arteries stenosis were less frequent in the native population of Yakutia than in migrants.
It is known that a range of nonbeverage alcohols including eau-de-colognes and medicinal tinctures are consumed by sections of the Russian population. Research conducted in a city in the Urals (2003 to 2005) showed that consumption of such products is associated with very high mortality from a wide range of causes. However, there have been no systematic attempts to investigate the extent to which such products are available in other cities of the Russian Federation. There is particular interest in establishing this following the introduction of new federal regulations in January 2006 aimed at restricting the availability of these products.
In the first half of 2007, we conducted a survey in 17 cities that spanned the full range of city types in the Russian Federation excluding those in the Far East. In each city, fieldworkers visited pharmacies and other types of retail outlets and purchased samples of nonbeverage alcohols. These were defined as being typically 10 to 15 roubles per bottle, with an ethanol concentration of at least 60% by volume.
We were able to purchase samples of nonbeverage alcohols in each of the 17 cities we investigated. The majority of the 271 products included were a cheaper and more affordable source of ethanol than standard Russian vodka. Medicinal tinctures, sold almost exclusively in pharmacies, were particularly common with an average concentration of 78% ethanol by volume. Most importantly, the majority of the products were of a sort that our previous research in 2004 to 2005 had established were drunk by working-age men.
While the 2006 federal regulations introduced in part to reduce the availability and consumption of nonbeverage alcohols may have had some effect on certain classes of nonmedicinal products, up until June 2007 at least, medicinal tinctures as well as some other nonbeverage alcohols that are consumed appear to have been readily available.
Elements of a "managed market" for health services have been introduced into the Russian health care system, which under the Soviet regime was run as a comprehensive state-managed system. The authors examine the recent development of health service reforms in a case study of the city of St. Petersburg and the surrounding Leningrad region. Evidence from key informants and a local survey of service users shows how alternative models of the managed market are being introduced in different parts of the study area. A critical review of the market-oriented strategies for reform emerging in the case study suggests that such reforms carry risks associated with the "traps of managed competition." Future policy for health service systems in Russia must take these risks more fully into account.
The paper presents the results of long-term monitoring of the content and interenvironmental distribution of the chemical elements Ni, Cd, Pb, Cr, Cu, Zn, Fe, and Mn over 1993-2007 in the environmental objects. The studies were made in the urbanized and rural areas of the Orenburg and Orsk-Troitsk industrial centers. General regularities were found in the quantitative distribution and priority relationships of the elements in the drinking water, in the atmosphere of residential areas (snow cover), in soil, foodstuffs, and children's biomedia.
Developing healthy communities. A five year project report from The Community Health Development Centre. Presented at The International Healthy Cities Conference. September 1994.
Weather-related health effects have attracted renewed interest because of the observed and predicted climate change. The authors studied the short-term effects of cold weather on mortality in 15 European cities. The effects of minimum apparent temperature on cause- and age-specific daily mortality were assessed for the cold season (October-March) by using data from 1990-2000. For city-specific analysis, the authors used Poisson regression and distributed lag models, controlling for potential confounders. Meta-regression models summarized the results and explored heterogeneity. A 1 degrees C decrease in temperature was associated with a 1.35% (95% confidence interval (CI): 1.16, 1.53) increase in the daily number of total natural deaths and a 1.72% (95% CI: 1.44, 2.01), 3.30% (95% CI: 2.61, 3.99), and 1.25% (95% CI: 0.77, 1.73) increase in cardiovascular, respiratory, and cerebrovascular deaths, respectively. The increase was greater for the older age groups. The cold effect was found to be greater in warmer (southern) cities and persisted up to 23 days, with no evidence of mortality displacement. Cold-related mortality is an important public health problem across Europe. It should not be underestimated by public health authorities because of the recent focus on heat-wave episodes.
Faculty of Physical and Health Education and Department of Public Health Sciences, Faculty of Medicine, University of Toronto, Toronto, Ont., Canada. royjshep@shaw.ca
Large amounts of motor performance test data have been collected in Canada, as in Europe and other countries, but even where representative population samples have been selected, interpretation of the findings is difficult, and most conclusions remain tenuous. Urban Canadian children apparently showed a small increase of physical performance from the mid- 1960s through to about 1980, related in part to intensive governmental promotion of physical fitness and changes in gender roles of female students over this period. The two most recent decades have been marked by a shift of focus to health-related tests, the results showing a small but progressive deterioration in health-related fitness, with an accumulation of body fat, as documented by increases in body mass indices and skinfold thicknesses. In 1970, the fitness levels of urban children were substantially inferior to that of Inuit students, living in the high arctic and practicing a traditional, physically active lifestyle. However, by 1990, the Inuit children had adopted many of the sedentary habits typical of Canadian city dwellers, and had lost much of their previous advantage. At this stage, most Canadian students were not reaching their fitness potential, but their physical condition could be enhanced - in urban centers by an augmented physical education programme, and in the Inuit community by participation in programmes of active leisure. At present, Canadian students seem to be somewhat more fit than those in the US, but less fit than their peers in some European countries. Nevertheless, international comparison of Canadian data is currently hampered by differences in measurement techniques and failure of many investigators to test representative population samples.
To describe the prevalence of overweight and obesity over 5 y among inner-city elementary schoolchildren aged 10-12 y in multiethnic, low-income neighborhoods in Montreal, Canada.
Height and weight of all students in grades 4-6 in 16 control schools participating in an evaluation of the impact of a school-based heart health promotion program, were measured each May/June from 1993 to 1997 in cross-sectional classroom-based school surveys.
The prevalence of overweight (> or = 85th age- and gender-specific percentile for body mass index (BMI) from NHANES I and II) was 35.9% in 1993; it increased by approximately 1.3% per year. The prevalence of obesity (> or = 95th age- and gender-specific percentile for BMI from NHANES I and II) was 15.9% in 1993; it increased by approximately 1.0% per year. In multivariate models predicting overweight and obesity, the odds ratios for year adjusted for age, sex, and family ethnic origin were 1.08 (95% confidence interval (CI), 1.04-1.12), and 1.09 (95%CI, 1.04-1.15), respectively.
There were significant secular trends of increasing overweight and obesity among young inner-city schoolchildren from the early to late 1990s. Preventive intervention is clearly indicated because childhood obesity tracks to adulthood and because obesity is associated with substantial morbidity, mortality and health care costs.
It is not known whether the recently described break in the trend in hip fracture incidence in many settings applies in both women and men, depends on changes in bone mineral density (BMD) or changes in other risk factors, or whether it is apparent in both urban and rural settings.
We evaluated changes in annual hip fracture incidence from 1987 to 2002 in Swedish men aged =60 years in one urban (n?=?25,491) and one rural population (n?=?16,432) and also secular differences in BMD, measured by single-photon absorptiometry at the distal radius and multiple other risk factors for hip fracture in a population-based sub-sample of the urban and the rural men aged 60-80 years in 1988/89 (n?=?202 vs. 121) and in 1998/99 (n?=?79 vs. 69).
No statistically significant changes in the annual age-adjusted hip fracture incidence per 10,000 were apparent from 1987 to 2002 in urban (0.38 per year, 95% CI -0.12 to 0.88) or rural men (-0.05 per year, 95% CI -0.63 to 0.53). BMD was similar in 1988/89 and 1998/99 when examining both urban (-19.6?mg/cm(2), 95% CI -42.6 to 3.5) and rural (-23.0?mg/cm(2), 95% CI -52.1 to 6.1) men.
Since no secular change in age-adjusted hip fracture incidence was found during the study period, a levelling off in hip fracture incidence is present also in Swedish men. Because BMD on a group level was similar in 1988/89 and 1998/99, changes in other risk factors ought to be either of minor importance or counteracted by changes in different risk factors.
Caring for people in the community with persistent and disabling mental illnesses presents a major challenge to government, planners and mental health professionals. The success with which mentally disabled people are integrated into community life says much about the society in which we live. This article describes the experience of the Greater Vancouver Mental Health Service Society in offering community-based mental health services to persons with schizophrenia and other major mental disorders over the past 20 years. The key to its success lies in a decentralized, relatively non hierarchical organizational structure which allows committed and skilled multidisciplinary teams to work with patients and their families in their community. The resulting services are fully integrated within the fabric of the community and are responsive to local needs. Partnerships among professionals, patients, families and community agencies result in work that is creative, productive and effective.
