A randomized controlled trial of an mHealth intervention for gay and bisexual men's mental, behavioral, and sexual health in a high-stigma, low-resource context: Project Comunică protocol

Background

The World Health Organization (WHO) reported that 80% of new HIV diagnoses in 2014 in Europe occurred in Central and Eastern Europe (CEE). Romania has particularly high HIV incidence, AIDS prevalence, and AIDS-related deaths. HIV incidence today in Romania is largely attributed to sexual contact among gay and bisexual men (GBM). However, homophobic stigma in Romania keeps GBM out of reach of the scant available prevention services and serves as a risk factor for HIV. The Comunică intervention delivers motivational interviewing and cognitive-behavioral therapy skills across eight live text-based counseling sessions. Preliminary evidence suggests that Comunică possesses promise for reducing GBM's co-occurring mental (e.g., depression), behavioral (e.g., heavy alcohol use), and sexual (e.g., HIV-transmission-risk behavior) health risks in Romania and perhaps other similar high-stigma national contexts. This paper describes a randomized controlled trial (RCT) designed to test the efficacy of Comunică.

Methods

To test Comunică's efficacy, 305 GBM were randomized to receive Comunică or a content-matched education attention control condition. The control condition consists of eight time-matched educational modules that present information regarding GBM identity development, information about HIV transmission and prevention, the importance of HIV/STI testing and treatment, heavy alcohol use and its associations with HIV-transmission-risk behavior, sexual health communication, finding social support, and creating sexual health goals. Outcomes are measured pre-intervention (baseline), and at 4-, 8-, and 12-month follow-ups. The primary outcome is frequency of condomless anal sex acts with HIV-positive or unknown-status partners outside of the context of one's own adherent PrEP use or primary partner's adherent PrEP use or undetectable viral load in the past 30 days at each follow-up. Secondary outcomes include depression, anxiety, suicidal thoughts, heavy alcohol use, and HIV/STI testing; motivational and stigma-related mechanisms of intervention efficacy will also be examined.

Discussion

If found to be efficacious, Comunică presents a scalable platform to provide mental, behavioral, and sexual health support to GBM living in Romania and similar high-stigma, low-resource areas within the CEE region and beyond.

Trial registration

Registered April 11, 2019 to ClinicalTrials.gov Identifier: NCT03912753.

Barriers in inflammatory bowel disease care in Central and Eastern Europe: a region-specific analysis

Inflammatory bowel diseases (IBD), including Crohn's disease and ulcerative colitis, are chronic immune-mediated diseases with a high incidence and prevalence in Europe. Since these are diseases with associated disability, they require complex management and the availability of high-quality healthcare resources. We focused on the analysis of IBD care in selected countries of Central and Eastern Europe (Croatia, the Czech Republic, Hungary, Moldova, Poland, Romania and Slovakia) targeting the availability and reimbursement of diagnostic and therapeutic modalities, the role of IBD centers and also education and research in IBD. As part of the analysis, we created a questionnaire of 73 statements organized in three topics: (1) diagnostics, follow-up and screening, (2) medications and (3) IBD centers. The questionnaire was filled out by co-authoring IBD experts from individual countries, and then the answers and comments on the questionnaire were analyzed. We identified that despite the financial burden, which still partially persists in the region, the availability of some of the cost-saving tools (calprotectin test, therapeutic drug monitoring) differs among countries, mainly due to variable reimbursement from country to country. In most participating countries, there also remains a lack of dedicated dietary and psychological counseling, which is often replaced by recommendations offered by gastroenterologists. However, there is adequate availability of most of the currently recommended diagnostic methods and therapies in each participating country, as well as the implementation of established IBD centers in the region.

Prevalence of Cardiovascular Risk Factors and Coronary Angiographic Findings in High-Risk Immigrant Communities in Italy

BACKGROUND

The prevalence of coronary artery disease (CAD) considerably varies by ethnicity. High-risk populations include patients from Eastern Europe (EEP), the Middle East and North Africa (MENAP) and South Asia (SAP).

METHODS

This retrospective study aims to highlight cardiovascular risk factors and specific coronary findings in high-risk immigrant groups. We examined the medical records and coronary angiographies of 220 patients from the above-mentioned high-risk ethnic groups referred for Acute Coronary Syndrome (ACS) and compared them with 90 Italian patients (IP) from 2016 to 2021. In the context of high-risk immigrant populations, this retrospective study aims to shed light on cardiovascular risk factors and particular coronary findings. We analyzed the medical records of 220 patients from the high-risk ethnic groups described above referred for ACS and compared them with 90 IPs between 2016 and 2021. In addition, we assessed coronary angiographies with a focus on the culprit lesion, mainly evaluating multi-vessel and left main disease.

RESULTS

The mean age at the first event was 65.4 ± 10.2 years for IP, 49.8 ± 8.5 years for SAP (Relative Reduction (ReR) 30.7%), 51.9 ± 10.2 years for EEP (ReR 26%) and 56.7 ± 11.4 years for MENAP (ReR 15.3%); p < 0.0001. The IP group had a significantly higher prevalence of hypertension. EEP and MENAP had a lower prevalence of diabetes. EEP and MENAP had a higher prevalence of STEMI events; SAP showed a significant prevalence of left main artery disease (p = 0.026) and left anterior descending artery disease (p = 0.033) compared with other groups. In SAP, we detected a higher prevalence of three-vessel coronary artery disease in the age group 40-50.

CONCLUSIONS

Our data suggest the existence of a potential coronary phenotype in several ethnicities, especially SAP, and understate the frequency of CV risk factors in other high-risk groups, supporting the role of a genetic influence in these communities.

HPV Vaccination and Cervical Cancer Screening Policies and Practices in 18 Countries, Territories and Entities across Eastern Europe and Central Asia

BACKGROUND

To assess readiness to achieve the WHO Global Strategy targets for HPV vaccination and cervical screening and to guide capacity building, the current status of these services in 18 Eastern European and Central Asian countries, territories and entities (CTEs) was evaluated.

METHODS

In order to assess the current status of HPV vaccination and cervical cancer screening in these 18 CTEs, a 30 question survey tool was developed, covering: national policies, strategies and plans for cervical cancer prevention; status of cancer registration; status of HPV vaccination; and current practices for cervical cancer screening and treatment of precancerous lesions. As cervical cancer prevention comes within the mandate of the United Nations Fund for Population Development (UNFPA), the UNFPA offices in the 18 CTEs have regular contact with national experts who are directly involved in cervical cancer prevention actions and are well placed to provide the data required for this survey. Working through the UNFPA offices, the questionnaires were sent to these national experts in April 2021, with data collected from April to July 2021. All CTEs returned completed questionnaires.

RESULTS

Only Armenia, Georgia, Moldova, North Macedonia, Turkmenistan and Uzbekistan have implemented national HPV vaccination programmes, with only the last 2 of these reaching the WHO target of 90% of girls fully vaccinated by age 15, while rates in the other 4 range from 8%-40%. Cervical screening is available in all CTEs but only Belarus and Turkmenistan have reached the WHO target of 70% of women screened once by age 35 and again by age 45, while rates elsewhere range from 2%-66%. Only Albania and Turkey follow the WHO recommendation to use a high-performance screening test, while the majority use cervical cytology as the main screening test and Kyrgyzstan, Tajikistan, Turkmenistan and Uzbekistan use visual inspection. No CTEs currently operate systems to coordinate, monitor and quality assure (QA) the entire cervical screening process.

CONCLUSIONS

Cervical cancer prevention services in this region are very limited. Achieving the WHO Global Strategy targets by 2030 will require substantial investments in capacity building by international development organisations.

Effect of remdesivir on mortality and the need for mechanical ventilation among hospitalized patients with COVID-19: real-world data from a resource-limited country

OBJECTIVES

Georgia introduced remdesivir for the treatment of COVID-19 in December 2020. We evaluated the real-world effect of remdesivir on mortality and the need for mechanical ventilation among inpatients with COVID-19.

METHODS

The study included 346 remdesivir recipients and 346 controls not receiving remdesivir selected through propensity score matching based on age, gender, presence of any chronic comorbid condition, and oxygen saturation at admission. Factors associated with in-hospital mortality and the need for mechanical ventilation were assessed in a multivariable logistic regression model.

RESULTS

The groups were comparable by age, gender, comorbidities, and baseline oxygen saturation. Among 346 remdesivir recipients, 265 (76.6%) received a generic formulation of the drug. Eight (2.3%) patients died in the remdesivir group and 18 (5.2%) in the control group (P = 0.046). In the multivariable analysis, remdesivir was associated with non-statistically significant reduced odds of death (odds ratio: 0.39, 95% confidence interval: 0.14-1.04, P = 0.06). Significantly fewer patients in the remdesivir group required mechanical ventilation compared to controls: 2.9% vs 6.4% (P = 0.03). Statistically significant difference was maintained in multivariable analysis (odds ratio: 0.40, 95% confidence interval: 1.04-5.60, P = 0.04).

CONCLUSION

Borderline reduction in the odds of death and statistically significant decrease in the need for mechanical ventilation support use of remdesivir in hospitalized patients with COVID-19.

Analysis and Forecast of Indicators Related to Medical Workers and Medical Technology in Selected Countries of Eastern Europe and Balkan

Health indicators measure certain health characteristics in a specific population or country and can help navigate the health systems. As the global population is rising, the demand for an increase in the number of health workers is simultaneously rising. The aim of this study was to compare and predict the indicators related to the number of medical workers and medical technologies in selected countries in Eastern Europe and Balkan in the studied period. The article analyzed the reported data of selected health indicators extracted from the European Health for All database. The indicators of interest were the number of physicians, pharmacists, general practitioners and dentists per 100,000 people. To observe the changes in these indicators through the available years, we used linear trends, regression analysis and forecasting to the year 2025. The regression analysis shows that the majority of the observed countries will experience an increase in the number of general practitioners, pharmacists, health workers/professionals and dentists, as well as in the number of computerized tomography scanners and the number of magnetic resonance units, predicted to occur by 2025. Following trends of medical indicators can help the government and health sector to focus and navigate the best investments for each country according to the level of their development.

Implications of the 2021 ESC cardiovascular risk classification among 283,000 European immigrants living in a low-risk region: a population-based analysis in Catalonia

INTRODUCTION

The ESC recently classified European countries into 4 cardiovascular risk regions. However, whether Europeans from higher-risk countries living in lower-risk regions may benefit from intensive cardiovascular prevention efforts is unknown. We described the burden of risk factors and cardiovascular disease (CVD) among European-born immigrants living in Catalonia, a low-risk region.

MATERIAL AND METHODS

A retrospective cohort study of 5.6 million adults of European origin living in Catalonia in 2019, including 282,789 European-born immigrants, was performed. We used the regionwide healthcare database and classified participants into 5 groups: low-, moderate-, high-, and very high-risk, and local-born. Age-standardized prevalence was estimated as of December 31^st, 2019 and incidence was computed during 2019 among at-risk individuals.

RESULTS

The very high-risk group was the largest immigrant group (N = 136,910; 48.4%), while the high-risk group was the smallest (N = 15,739; 5.6%). These two had the highest burden of coronary heart disease across all groups evaluated, in both men and women. The very high-risk group also had the highest prevalence of hypertension and obesity at young-to-middle age, and the burden of risk factors newly diagnosed during 2019 was highest in high- and very high-risk participants. The mean age at first diagnosis of risk factors and CVD was lower in these groups.

CONCLUSIONS

In Catalonia, residents born in high- and very-high-risk European countries are at increased risk of coronary heart disease and newly diagnosed risk factors. Low-risk European countries may consider tailored prevention efforts, early screening of risk factors, and adequate healthcare resource planning to better address the health needs of men and women from higher-risk countries.

Revival of psychology in former Czechoslovakia and the contemporary Czech Republic after the fall of Totalitarian communist regimes

After the general societal and political change in November 1989 in Czechoslovakia, the subject "History of Psychology" became the stable component of curriculum of studying psychology at the Department of Psychology of Faculty of Arts of Charles University in Prague. The author of this paper has taught "History of Psychology" in Czech since 1998 for more than 20 years all students of psychology and he is teaching this subject the students of ERASMUS+ program from whole Europe, studying at Charles University in Prague, now. Indivisible part of the curriculum is represented by the history of Czechoslovak and Czech psychology. In References, the most important publications in the field of history of Czechoslovak and Czech psychology are presented.

"Coming Out To Yourself": Reflections On Early-Years Sexual Identity Formation Among Different Generations of Bulgarian Non-Heterosexual Males

During the past few years the so-called "anti-gender campaigns" in Bulgaria have revitalized the polemics surrounding the development of non-heterosexual identities claiming that these identities are "imported" by "Western" politics and discourses in order to "weaken" and transform national cultural and political models. Analyzing 63 semi-structured in-depth interviews with non-heterosexual males from different generations, this study aims to contribute to the theories of non-heterosexual identity development by providing data from Bulgarian context. The data from this study suggests that: (1) non-heterosexual male identities in Bulgaria have existed before the "global gay culture"; (2) the younger the participants the earlier they realize their non-heterosexual desires often within the "pre-sexuality stage" defined by the stage models and the youngest cohort self-label their same-sex attraction mainly through an "identity-centred" sequence, before engaging in sexual activities; (3) the greater awareness of role models, the wider access to information, and the involvement in the LGBTQI + communities have contributed to a more positive and self-respectful identity development; (4) physical contacts and observations as significant sources for the questioning of a non-heterosexual identity have been replaced by virtual observations and communication; (5) the Internet and social media have made non-heterosexual identity development more accessible regardless of social and economic background, and that (6) non-heterosexual identity development does not lead automatically to a culturally defined gay identity.

Women's perspectives on the quality of maternal and newborn care in childbirth during the COVID-19 pandemic in Latvia: Results from the IMAgiNE EURO study on 40 WHO standards-based quality measures

OBJECTIVE

To investigate women's perspectives on the quality of maternal and newborn care (QMNC) around the time of childbirth during the COVID-19 pandemic in Latvia, comparing the years 2020 and 2021, among women who went into labor or had a prelabor cesarean.

METHODS

Women giving birth in healthcare facilities in Latvia from March 1, 2020, to October 28, 2021, answered an online questionnaire including 40 WHO standards-based quality measures. Descriptive and multivariate quantile regression analyses were performed to compare QMNC in 2020 and 2021.

RESULTS

2079 women were included in the analysis: 1860 women who went into labor (group 1) and 219 with prelabor cesarean (group 2). Among group 1, 66.4% (n = 99/149) of women received fundal pressure in an instrumental vaginal birth, 43.5% (n = 810) lacked involvement in choices, 17.4% (n = 317) reported suffering abuse, 32.7% (n = 609) reported inadequate breastfeeding support while 5.2% (n = 96) lack of early breastfeeding. A significant reduction in QMNC due to the COVID-19 pandemic was reported by 29.5% (n = 219) and 25.0% (n = 270) of respondents in 2020 and 2021, respectively (P = 0.045). Multivariate analyses highlighted a significantly lower QMNC index for 2020 compared with 2021 (P < 0.001).

CONCLUSION

This first study investigating QMNC in Latvia showed significant gaps in QMNC perceived by respondents, with slightly better results in 2021. Appropriate healthcare strategies to improve health care for women and newborns in Latvia are required.

CLINICALTRIALS

gov Identifier:NCT04847336.

HIV Pre-Exposure Prophylaxis in Central and Eastern Europe-Gains and Challenges in An Ever-Changing World

Pre-exposure prophylaxis (PrEP) is an effective prevention tool for controlling the HIV epidemic. Since its approval in the United States in 2012 and Europe in 2016, it has become available on a global scale offered as a registered strategy in clinical studies or demonstration projects with a slow and steady increase. In the second quarter of 2022, PrEP became available in 78 countries globally, with around 3 million people having started using PrEP. Europe has been much slower than the rest of the world to roll out PrEP; nevertheless, currently, PrEP is nationally available and reimbursed in 21 countries; generics are available but not reimbursed in 14 countries. PrEP is not formally implemented in 20 countries, which are mostly Central and Eastern European countries. There are significant disparities between countries in terms of PrEP availability, accessibility, and usage, most likely due to social, cultural, and political differences. The major barriers to PrEP use are reported to be lack of knowledge of people in need, not being reimbursed, and low perception of HIV. PrEP uptake globally and regionally still lacks the power to have an impact on controlling the epidemic. High prioritization of PrEP targets will offer us a realistic chance of reaching the Joint United Nations Programme on HIV/AIDS (UNAIDS) goal of a 90% reduction in HIV infections by 2030 compared to 2010.

Carbon isotope discrimination as a key physiological trait to phenotype drought/heat resistance of future climate-resilient German winter wheat compared with relative leaf water content and canopy temperature

Climate change is expected to influence crop growth through frequent drought and heat extremes, and thus, drought and heat tolerance are of increasing importance as major breeding goals for cereal crops in Central Europe. Plant physiological water status traits are suitable for phenotyping plant drought/heat tolerance. The objective of this study was to determine whether relative leaf water content (RLWC), plant canopy temperature (CT), and carbon isotope discrimination (CID) are suitable for phenotyping the drought/heat resistance of German winter wheat for future climate resilience. Therefore, a comprehensive field evaluation was conducted under drier and warmer conditions in Moldova using a space-for-time approach for twenty winter wheat varieties from Germany and compared to twenty regionally adapted varieties from Eastern Europe. Among the physiological traits RLWC, CT, and CID, the heritability of RLWC showed the lowest values regardless of year or variety origin, and there was no significant correlation between RLWC and grain yield regardless of the year, suggesting that RLWC did not seem to be a useful trait for distinguishing origins or varieties under continental field conditions. Although the heritability of CT demonstrated high values, the results showed surprisingly low and nonsignificant correlations between CT and grain yield; this may have been due to a confounding effect of increased soil temperature in the investigated dark Chernozem soil. In contrast, the heritability of CID in leaves and grain was high, and there were significant correlations between grain yield and CID, suggesting that CID is a reliable indirect physiological trait for phenotyping drought/heat resistance for future climate resilience in German wheat.

Transition of the automotive industry towards electric vehicle production in the east European integrated periphery

This article analyzes the progress of the transition from the production of vehicles with internal combustion engines to the production of electric vehicles in eastern Europe. The transition is considered in the context of the development of the automotive industry in eastern Europe since the early 1990s and the relative position of the east European integrated periphery in the European automotive industry value chains and production networks. The article argues that foreign firms are driving the transition, while the role of the east European governments and local firms is much less significant. The transition is slower than in western Europe and eastern Europe will continue to produce internal combustion engine vehicles longer. Eastern Europe will continue to rely on its competitive advantage of low production costs, especially low labor costs, to continue to attract foreign direct investment in the automotive industry. The article considers the consequences of the transition for the position of east European countries in automotive value chains, production networks and the division of labor in the European automotive industry.

HIV treatment strategies across Central, Eastern and Southeastern Europe: New times, old problems

INTRODUCTION

In the last decade, substantial differences in the epidemiology of, antiretroviral therapy (ART) for, cascade of care in and support to people with HIV in vulnerable populations have been observed between countries in Western Europe, Central Europe (CE) and Eastern Europe (EE). The aim of this study was to use a survey to explore whether ART availability and therapies have evolved in CE and EE according to European guidelines.

METHODS

The Euroguidelines in Central and Eastern Europe (ECEE) Network Group conducted two identical multicentre cross-sectional online surveys in 2019 and 2021 concerning the availability and use of antiretroviral drugs (boosted protease inhibitors [bPIs], integrase inhibitors [INSTIs] and nucleoside reverse transcriptase inhibitors [NRTIs]), the introduction of a rapid ART start strategy and the use of two-drug regimens (2DRs) for starting or switching ART. We also investigated barriers to the implementation of these strategies in each region.

RESULTS

In total, 18 centres participated in the study: four from CE, six from EE and eight from Southeastern Europe (SEE). Between those 2 years, older PIs were less frequently used and darunavir-based regimens were the main PIs (83%); bictegravir-based and tenofovir alafenamide-based regimens were introduced in CE and SEE but not in EE. The COVID-19 pandemic did not significantly interrupt delivery of ART in most centres. Two-thirds of centres adopted a rapid ART start strategy, mainly in pregnant women and to improve linkage of care in vulnerable populations. The main obstacle to rapid ART start was that national guidelines in several countries from all three regions did not support such as strategy or required laboratory tests first; an INSTI/NRTI combination was the most commonly prescribed regimen (75%) and was exclusively prescribed in SEE. 2DRs are increasingly used for starting or switching ART (58%), and an INSTI/NRTI was the preferred regimen (75%) in all regions and exclusively prescribed in SEE, whereas the use of bPIs declined. Metabolic disorders and adverse drug reactions were the main reasons for starting a 2DR; in the second survey, HIV RNA <500 000 c/ml and high cluster of differentiation (CD)-4 count emerged as additional important reasons.

CONCLUSIONS

In just 2 years and in spite of the emergence of the COVID-19 pandemic, significant achievements concerning ART availability and strategies have occurred in CE, EE and SEE that facilitate the harmonization of those strategies with the European AIDS Clinical Society guidelines. Few exceptions exist, especially in EE. Continuous effort is needed to overcome various obstacles (administrative, financial, national guideline restrictions) in some countries.

The clean development mechanism in Eastern Europe: an in-depth exploration

The Clean Development Mechanism (CDM), a partnership tool founded under the Kyoto Protocol, grants potential opportunities to help developing countries achieve sustainable development. The present research examines the CDM projects in Eastern Europe (Moldova, Serbia, Bosnia and Herzegovina, Montenegro, and Albania). Although there were far fewer projects in this region than, for instance, China or India, it has some specific features that make it worth studying. Major findings are that most CDM projects in Eastern Europe involved a changing combination of two or more sources of financing, and the distribution of projects in the region was uneven. Moreover, although there was a small number of projects overall, they were all cost-effective, long-term and large-scale. The findings of the research call for improvements to be made to the governance of the CDM, by strengthening the international and national regulation of projects and by aggregating the scales of decision-making and actions so that real multi-scalar transnational governance - from the global level down to the local level - is implemented in a coherent manner. It is also recommended to carry out ex-post project evaluations, following which readjustments could be made.

COVID19: A blessing in disguise for European stock markets?

This study aims to bridge the gap that has remained unfilled after the initial scrutiny and reporting of the damaging effects of Covid-19 on financial markets. The study analyzes 10 European stock markets and compares their pre and post covid return dynamics. Our findings are surprisingly pleasant, albeit counterintuitive to some. We observe a quick and unprecedented recovery in the European stock market, yielding significantly higher returns post covid, given a reasonably large holding period. We also observe an alteration and change in the status quo of countries while transmitting or receiving cross-market spillovers.

Unravelling the origin of the common wall lizards (Podarcismuralis) in south-eastern Europe using mitochondrial evidence

The origin of the common wall lizards (Podarcismuralis) populations in south-eastern Europe (namely in Bulgaria and Romania), representing the north-eastern range border of this species, was addressed using mitochondrial DNA. We compared cytochrome b sequences from Bulgaria and Romania with those from the contiguous range in Central Europe that are available from previous studies. We recorded five main haplogroups in Bulgaria and Romania, belonging to the Central Balkan clade. However, haplogroup III was recorded in more localities than previously found. Additionally, signs of haplotype admixture were identified in several populations along the Danube River. The presence of the Southern Alps haplotype in one population from Otopeni, Bucharest (Romania) and its close phylogenetic relationships to north Italy populations suggests human-mediated introductions of this wall lizard clade in Romania. Our results confirm that P.muralis can have non-native lineages and admixture through active human-mediated transport.

COVID-19-related anxieties do not decrease support for liberal democracy

The COVID-19 pandemic led to widespread fear among the population. Early studies suggested that this resulted in exclusionary attitudes and increased support for discriminatory policy measures. We still lack an understanding of the longer-term, potentially erosive consequences that COVID-19-specific anxieties may carry for citizens' commitment to liberal democratic norms. In this research note, we present evidence from an original experiment in which we manipulate individuals' cognitive accessibility of their fears related to COVID-19. We implemented this experiment in Hungary and Romania - two cases where illiberal attitudes are most likely to amplify under conditions of fear - a year and a half after the outbreak of the pandemic. The results show that our intervention is successful in elevating respondents' levels of worry, anxiety and fear when thinking about infectious diseases like COVID-19. However, these emotions do not carry secondary effects on individuals' levels of right-wing authoritarianism, nationalism or outgroup hostility, nor do they affect preferences for specific discriminatory policy measures aimed to fight a potential resurgence of COVID-19. We discuss these findings in light of the literature on the demand-side determinants of democratic backsliding and the consequences of emotions on political behaviour.

Changes in the Number of Physicians and Hospital Bed Capacity in Europe

OBJECTIVES

Our aim was to examine the numbers of practicing physicians and total numbers of hospital beds in European Organisation for Economic Co-operation and Development countries.

METHODS

Data analyzed were derived from the "Organisation for Economic Co-operation and Development Health Statistics 2020" database between 1980 and 2018. The selected countries were compared according to the type of healthcare system and geographical location by parametric and nonparametric tests.

RESULTS

In 1980, Bismarck-type systems showed an average number of physicians of 2.3 persons/1000 population; in Beveridge-type systems, it was 1.7 persons. By 2018, it leveled out reaching 3.9 persons in both healthcare system types. In 1980, average physician number/1000 was 2.5 persons in Eastern Europe; in Western Europe, it was 1.9 persons. By 2018 this proportion changed with Western Europe having the higher number (3.7 persons; 3.9 persons). In 1980, average number of hospital beds/1000 population was 9.6 in Bismarck-type systems whereas in Beveridge-type systems it was 8.8. By 2018, it decreased to 5.6 in Bismarck-type systems (-42%) and to 3.1 in Beveridge-type systems (-65%). In 1980, the average number of hospital beds/1000 population in Eastern Europe was 10.3; in Western Europe, it was 8.5. By 2018, the difference between the 2 regions did not change.

CONCLUSIONS

Although the number of physicians was 33% higher in 1980 in Eastern Europe than in Western Europe, by 2018 the number of physicians was 5% higher in Western Europe. In general, regardless of the healthcare system and geographical location, the proportion of physicians per 1000 population has improved due to a larger decrease in the number of hospital beds.

Street Food and Takeaway Food Purchasing Patterns in Bosnia and Herzegovina

This study aimed to describe street food and takeaway food purchasing patterns in Sarajevo and Banja Luka, throughout the day and by city location. A cross-sectional evaluation of street food and takeaway food customers was conducted in 2017. All eligible vending sites (n = 348) in the vicinity of selected markets and bus stops were included. Data on the food items purchased, and time and geographic location of the purchases were collected. A total of 755 customers purchased 929 food items. Takeaway venues showed higher customer influx (5.0 vs. 2.0 customers observed per 10 min of observation, p < 0.001) and buying rates (6.7 vs. 2.0 items bought per 10 min of observation, p < 0.001; 1.5 vs. 1.0 items bought per customer, p < 0.001) than street food sites. These rates were higher in city peripheries for street food venues, and in city centres for takeaway establishments. The purchase of industrial food products prevailed throughout the day in street food venues, whereas most takeaway purchases comprised homemade foods, with or without industrial beverages. The proportion of customers buying foods and beverages together was higher in takeaway venues (15.3% vs. 6.0%, p < 0.001), especially during lunchtime and in city centres. In street food vending sites, sweet and savoury snacks seemed to be preferred in the afternoon, whereas in takeaway food establishments, savoury pastries and main dishes were mostly purchased at breakfast or lunch, and bread during the morning. Soft drinks and industrial juices were frequently purchased in both types of vending site and at all hours of the day, particularly in the afternoon. Our findings provide an overview of street food and takeaway food buying habits and consumer demands in these cities, reflecting local food culture and dietary behaviours. The identification of the meal contexts and city sub-regions in which specific purchasing practices emerge point to potential priority targets. These insights can be useful when designing interventions adapted to the specificities of these food environments and the food habits of customers.

Air Pollution, Political Corruption, and Cardiovascular Disease in the Former Soviet Republics

Background

Ambient air pollution is a serious problem in many Eastern European countries. Elevated levels of fine airborne particulate matter (PM_2.5) pollution in the former Soviet republics relative to the rest of Europe contribute to elevated rates of disease, especially cardiovascular disease (CVD).

Objective

Information on the underlying social and political causes of air pollution in Eastern Europe is important for pollution control and disease prevention.

Methods

To quantify relationships between pollution, and air-pollution-related CVD, and political corruption throughout Europe and particularly in the former Soviet republics, we relied on the State of Global Air report for information on air pollution levels; on the 2019 Global Burden of Disease study (GBD) for estimates of the burden of air-pollution-related CVD; and on Transparency International (TI) for rankings of governmental corruption.

Findings

Air-pollution-related CVD was responsible for an estimated 178,000 (UI: 112,000-251,000) premature deaths and for the loss of 4,010,000 (UI: 2,518,000--5,611,000) productive years of life (DALYs) in 2019 in the former Soviet republics. A significant positive correlation (R = 0.72, p 1.7e-8) was found across Europe between air-pollution-related CVD mortality rates and national corruption rankings.

Conclusions

We conclude that lack of governmental transparency, inadequate air pollution monitoring, and opposition by vested interests have hindered air pollution control and perpetuated high rates of pollution-related morbidity and mortality in the former Soviet republics. Ending corruption and modernizing industrial production will be key to air pollution and related diseases.

Inhabiting Dispossession in the Post-Socialist City: Race, Class, and the Plan, in Bucharest, Romania

The paper explores the racialised geography of a series of socialist blocs located in the southern periphery of Bucharest, labelled as a contemporary Romanian "ghetto". Through extensive ethnographic and archival work, it expands on contemporary Western race-aware urban scholarship, advancing an expansive reading of the "plan" as a key element to account for the endurance of foundational dispossession in the context of Bucharest. The goal is to trace how the social segmentations of "class" and "race" have been diagrammed through discontinuous city-making in the last hundred years, refuting a reading of these complex processes as a matter of evolutionary stages between economic regimes, which ends up reproducing a stereotypical representation of the Eastern "other". The paper contributes to a situated approach to racial urbanism, offering the basis for a trans-Atlantic dialogue around the makings and unmakings of urban dispossession.

An Epidemiological Analysis of Terrorism-Related Attacks in Eastern Europe from 1970 to 2019

INTRODUCTION

Over the past five decades, Eastern Europe has seen relatively little in terms of terrorist attacks. The recent escalation of the Russo-Ukrainian conflict has, however, placed a new spotlight on the region, and new questions and concerns around war, conflict, insurgency, and terrorism are being posed. The Russian invasion and extensive combat operations, the largest in Europe since World War II, are occurring across Ukraine where there are 15 active nuclear reactors, not including the Chernobyl site, that are vulnerable to attack or sabotage. In addition, Eastern Europe has been heavily affected by COVID-19, exposing broad vulnerabilities in an otherwise fragile health care system. This raises concerns over the ability of Eastern European health care institutions to absorb surge and manage terrorist attacks or acts of violent extremism. This study provides an epidemiological description of all terrorism-related fatalities and injuries in Eastern Europe sustained from 1970 - 2019.

METHOD

Data collection was performed using a retrospective database search through the Global Terrorism Database (GTD). The GTD was searched using the internal database functions for all terrorism events which occurred in Eastern Europe from January 1, 1970 - December 31, 2019. Years 2020 and 2021 were not yet available at the time of this study. Primary weapon type, country where the incident occurred, and number of deaths and injured were collated. Results were exported into an Excel spreadsheet (Microsoft Corp.; Redmond, Washington USA) for analysis.

RESULTS

There were 3,901 terrorism-related events in Eastern Europe between the years 1970 and 2019, inclusive. In total, the attacks resulted in 5,391 deaths and 9,538 persons injured. Explosives were the most commonly used weapon type in 59.2% of all attacks in the region, followed by firearms in 27.6%.

CONCLUSION

From 1970 through 2019, a total of 3,901 terrorist attacks occurred in Eastern Europe, inflicting 5,391 deaths and 9,538 injuries. Of those, 72.3% occurred in Russia and Ukraine. Terrorist attacks sharply declined since the peak in 2014, but there is an overall uptrend in attacks since the 1970s.

"Transsexuality" and gender ratio in Poland: A case study on the East/West dichotomy

The article investigates scientific and journalistic discourses around differences in gender ratio among trans persons. The disparity between Poland and many other countries that was first noted in the 1980s was repeatedly associated with the different gender politics in the capitalist West and the (post) state-socialist East. Using Foucauldian methodology, the article claims that this discourse was constructed such that Poland's ratio-and consequently Poland's gender order-would always appear problematic, while Western countries were considered an invisible standard. Discourses around this ratio elucidate the role of heteronormativity and biological essentialism in the construction of the category of "transsexuality" in state-socialist Poland. The analysis also reveals that chronologies of LGBT and feminist movements had direct consequences for the theoretical and cultural spaces of trans identities.

Medical Communication during the Transition to Palliative Care in Pediatric Oncology in Hungary-The Parents' Perspective

The transition to palliative care (PC) is a critical aspect of pediatric oncology, and it requires a high level of communication skills from doctors, which could be best judged by the parents of children who have died from cancer. Our aim was to explore the parents' perspectives regarding the timing of the consultation on the implementation of PC, as well as facets of verbal and nonverbal communication in Hungary. Semistructured interviews were conducted with parents who had lost a child to cancer within the past 1-5 years. Interview transcripts (n = 23) were scrutinized with interpretative phenomenological analysis. The parents frequently associated palliation with end-of-life care and they clearly delimited the transition to PC after curative treatments had been exhausted. The parents were ambivalent with regard to the use of the word "death" during this consultation, and they often did not receive information on what to expect (e.g., regarding symptoms) or on who to turn to for further information or support (e.g., concerning bereavement). Although significant progress could be observed in the organization of pediatric palliative care in Hungary, there is still no widely accepted communication method for the transition to sole PC. There is a need for a culturally sensitive approach to refining the recommendations on the word use and communication protocol in pediatric PC in Hungary.