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Pikala M, Burzyńska M. The Burden of Suicide Mortality in Poland: A 20-Year Register-Based Study (2000-2019). Int J Public Health 2023; 68:1605621. [PMID: 36816833 PMCID: PMC9931732 DOI: 10.3389/ijph.2023.1605621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 01/20/2023] [Indexed: 02/05/2023] Open
Abstract
Objectives: The aim of the study was to assess mortality trends due to suicide in Poland in the years 2000-2019 with the use of joinpoint regression. Methods: The study analysed all suicide deaths in Poland in the years 2000-2019 (N = 113,355). Age-standardised death rates (SDRs), the annual percentage change (APC) and the average annual percentage change (AAPC) were determined. Results: In the male group, SDR was 29.3 in 2000 and 21.6 in 2019, in the female group, SDR decreased from 5.2 to 3.0. In 2019, the highest SDR values were noted in the group aged between 45 and 64 years. The most common method of suicide was hanging. In 2019, odds ratios (OR) of death due to suicide for age groups 15-24 years vs. 65 years or above were 51.47 among men and 181.89 among women. With regards to primary vs. tertiary education, OR values were 1.08 and 0.25, respectively; for single vs. widowed individuals 8.22 and 12.35; while for rural vs. urban residents 1.60 and 1.15. Conclusion: There is a need to implement educational programmes, primarily designed for young people.
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Affiliation(s)
- Małgorzata Pikala
- Department of Epidemiology and Biostatistics, Social and Preventive Medicine, Medical University of Lodz, Łódź, Poland
| | - Monika Burzyńska
- Department of Epidemiology and Biostatistics, Social and Preventive Medicine, Medical University of Lodz, Łódź, Poland
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Bikov A, Frent S, Pleava R, Kunos L, Bokhari S, Meszaros M, Mihaicuta S. The Burden of Associated Comorbidities in Patients with Obstructive Sleep Apnea-Regional Differences in Two Central-Eastern European Sleep Centers. J Clin Med 2020; 9:jcm9113583. [PMID: 33172084 PMCID: PMC7694741 DOI: 10.3390/jcm9113583] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/05/2020] [Accepted: 11/02/2020] [Indexed: 02/07/2023] Open
Abstract
Background: Obstructive sleep apnea (OSA) is usually associated with cardiovascular and cerebrovascular disease, metabolic syndrome and depression. Data on relevant OSA-associated comorbidities in Central–European populations are scarce. The aim of this study was to compare the prevalence of comorbidities in two OSA cohorts from Hungary and Romania. Methods: Data from 588 (282 from Hungary, 306 from Romania) untreated patients with OSA were retrospectively analyzed. The prevalence rates of hypertension, diabetes, dyslipidemia, allergic rhinitis, asthma, chronic obstructive pulmonary disease (COPD), osteoporosis, cerebrovascular and cardiovascular disease, arrhythmia and depression were compared between the two populations following adjustment for demographics, body mass index, smoking history, comorbidities and sleep parameters. Results: The prevalence rates of hypertension, arrhythmia, cerebrovascular and cardiovascular disease, diabetes and COPD in the whole study population were directly related to the severity of OSA. We found an inverse correlation between the prevalence of osteoporosis and OSA severity (all p < 0.05). Following adjustment, the prevalence of dyslipidemia was higher in the Hungarian cohort, whilst the prevalence of asthma, cardiovascular and cerebrovascular diseases was higher in the Romanian cohort (all p < 0.05). Conclusions: There was no difference in the prevalence rate of most comorbidities in patients with OSA from the two cohorts, except for dyslipidemia, asthma, cardiovascular and cerebrovascular disease.
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Affiliation(s)
- Andras Bikov
- Department of Pulmonology, Semmelweis University, Budapest 1085, Hungary; (A.B.); (L.K.); (M.M.)
- North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester M239LT, UK;
- Division of Infection, Immunity & Respiratory Medicine, University of Manchester, Manchester M239LT, UK
| | - Stefan Frent
- Department of Pulmonology, University of Medicine and Pharmacy, Timisoara 300041, Romania;
- Correspondence:
| | - Roxana Pleava
- Department of Cardiology, University of Medicine and Pharmacy, Timisoara 300041, Romania;
| | - Laszlo Kunos
- Department of Pulmonology, Semmelweis University, Budapest 1085, Hungary; (A.B.); (L.K.); (M.M.)
| | - Saba Bokhari
- North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester M239LT, UK;
| | - Martina Meszaros
- Department of Pulmonology, Semmelweis University, Budapest 1085, Hungary; (A.B.); (L.K.); (M.M.)
| | - Stefan Mihaicuta
- Department of Pulmonology, University of Medicine and Pharmacy, Timisoara 300041, Romania;
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Mikulík R, Caso V, Bornstein NM, Svobodová V, Pezzella FR, Grecu A, Simsic S, Gdovinova Z, Członkowska A, Mishchenko TS, Flomin Y, Milanov IG, Andonova S, Tiu C, Arsovska A, Budinčević H, Groppa SA, Bereczki D, Kõrv J, Kharitonova T, Vosko MR. Enhancing and accelerating stroke treatment in Eastern European region: Methods and achievement of the ESO EAST program. Eur Stroke J 2020; 5:204-212. [PMID: 32637654 PMCID: PMC7313365 DOI: 10.1177/2396987319897156] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 12/03/2019] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Despite the availability of prevention and therapies of stroke, their implementation in clinical practice, even of low-cost ones, remains poor. In 2015, the European Stroke Organisation (ESO) initiated the ESO Enhancing and Accelerating Stroke Treatment (EAST) program, which aims to improve stroke care quality, primarily in Eastern Europe. Here, we describe its methods and milestones. PATIENTS AND METHODS The ESO EAST program is using an implementation strategy based on a 'detecting-understanding-reducing disparities' conceptual framework: stroke care quality is first measured (after developing a platform for data collection), gaps are identified in the current service delivery, and ultimately feedback is provided to participating hospitals, followed by the application of interventions to reduce disparities. The ESO EAST program is carried out by establishing a stroke quality registry, stroke management infrastructure, and creating education and training opportunities for healthcare professionals. RESULTS Program management and leadership infrastructure has been established in 19 countries (Country Representatives in 22 countries, National Steering Committee in 19 countries). A software platform for data collection and analysis: Registry of Stroke Care Quality was developed, and launched in 2016, and has been used to collect data from over 90,000 patients from >750 hospitals and 56 countries between September 2016 and May 2019. Training in thrombolysis, nursing and research skills has been initiated. DISCUSSION ESO EAST is the first pan-Eastern European (and beyond) multifaceted quality improvement intervention putting evidence-informed policies into practice. Continuous monitoring of stroke care quality allows hospital-to-hospital and country-to-country benchmarking and identification of the gaps and needs in health care.
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Affiliation(s)
- Robert Mikulík
- International Clinical Research Center and Department of Neurology, St. Anne's University Hospital and Medical Faculty of Masaryk University, Brno, Czech Republic
| | - Valeria Caso
- Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Natan M Bornstein
- Shaare Zedek Medical center, Jerusalem, Tel Aviv University, Tel Aviv, Israel
| | - Veronika Svobodová
- International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
| | | | - Andreea Grecu
- International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
| | - Steven Simsic
- International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
| | - Zuzana Gdovinova
- Faculty of Medicine, Department of Neurology, P.J. Šafárik University, University Hospital L. Pasteur, Košice, Slovakia
| | - Anna Członkowska
- 2nd Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Tamara S Mishchenko
- Department of Clinical Neurology, Psychiatry and Narcology, V.N. Karazin Kharkiv National University, Kharkiv, Ukraine
| | - Yuriy Flomin
- Comprehensive Stroke Unit, MC 'Universal Clinic 'Oberig', Kyiv, Ukraine
| | - Ivan G Milanov
- Neurology Clinic, Medical University of Sofia, Sofia, Bulgaria
| | - Silva Andonova
- Medical University – Varna, University Hospital “St. Marina” Second Clinic of Neurology with ICU and Stroke Unit, Varna, Bulgaria
| | - Cristina Tiu
- Department of Clinical Neurosciences, University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania
| | - Anita Arsovska
- University Clinic of Neurology, Medical Faculty, University “Ss. Cyril and Methodius”, Skopje, North Macedonia
| | - Hrvoje Budinčević
- Department of Neurology, Stroke and Intensive Care Unit, Sveti Duh University Hospital, Zagreb, Croatia
| | - Stanislav A Groppa
- Department of Neurology and Neurosurgery, National Center of Epileptology, Institute of Emergency Medicine, Chisinau, Moldova
- Laboratory of Neurobiology and Medical Genetics, State University of Medicine and Pharmacy “Nicolae Testemiţanu,” Chisinau, Moldova
| | - Daniel Bereczki
- Department of Neurology, Semmelweis University, Budapest, Hungary
| | - Janika Kõrv
- Department of Neurology and Neurosurgery, Institute of Clinical Medicine, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - Tatiana Kharitonova
- Department of Acute Cerebrovascular Pathology and Emergency Neurology, Research Institute of Emergency Medicine n.a. I.I. Dzhanelidze, Saint-Petersburg, Russia
| | - Milan R Vosko
- Department of Neurology, Med Campus III, Kepler University Hospital, Linz, Austria
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Gańczak M, Miazgowski T, Kożybska M, Kotwas A, Korzeń M, Rudnicki B, Nogal T, Andrei CL, Ausloos M, Banach M, Brazinova A, Constantin MM, Dubljanin E, Herteliu C, Hostiuc M, Hostiuc S, Jakovljevic M, Jozwiak JJ, Kissimova-Skarbek K, Król ZJ, Mestrovic T, Miazgowski B, Milevska Kostova N, Naghavi M, Negoi I, Negoi RI, Pana A, Rubino S, Sekerija M, Sierpinski R, Szponar L, Topor-Madry R, Vujcic IS, Widecka J, Widecka K, Wojtyniak B, Zadnik V, Kopec JA. Changes in disease burden in Poland between 1990-2017 in comparison with other Central European countries: A systematic analysis for the Global Burden of Disease Study 2017. PLoS One 2020; 15:e0226766. [PMID: 32119685 PMCID: PMC7051048 DOI: 10.1371/journal.pone.0226766] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 12/03/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Systematic collection of mortality/morbidity data over time is crucial for monitoring trends in population health, developing health policies, assessing the impact of health programs. In Poland, a comprehensive analysis describing trends in disease burden for major conditions has never been published. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides data on the burden of over 300 diseases in 195 countries since 1990. We used the GBD database to undertake an assessment of disease burden in Poland, evaluate changes in population health between 1990-2017, and compare Poland with other Central European (CE) countries. METHODS The results of GBD 2017 for 1990 and 2017 for Poland and CE were used to assess rates and trends in years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life years (DALYs). Data came from cause-of-death registration systems, population health surveys, disease registries, hospitalization databases, and the scientific literature. Analytical approaches have been used to adjust for missing data, errors in cause-of-death certification, and differences in data collection methodology. Main estimation strategies were ensemble modelling for mortality and Bayesian meta-regression for disability. RESULTS Between 1990-2017, age-standardized YLL rates for all causes declined in Poland by 46.0% (95% UI: 43.7-48.2), YLD rates declined by 4.0% (4.2-4.9), DALY rates by 31.7% (29.2-34.4). For both YLLs and YLDs, greater relative declines were observed for females. There was a large decrease in communicable, maternal, neonatal, and nutritional disease DALYs (48.2%; 46.3-50.4). DALYs due to non-communicable diseases (NCDs) decreased slightly (2.0%; 0.1-4.6). In 2017, Poland performed better than CE as a whole (ranked fourth for YLLs, sixth for YLDs, and fifth for DALYs) and achieved greater reductions in YLLs and DALYs than most CE countries. In 2017 and 1990, the leading cause of YLLs and DALYs in Poland and CE was ischaemic heart disease (IHD), and the leading cause of YLDs was low back pain. In 2017, the top 20 causes of YLLs and YLDs in Poland and CE were the same, although in different order. In Poland, age-standardized DALYs from neonatal causes, other cardiovascular and circulatory diseases, and road injuries declined substantially between 1990-2017, while alcohol use disorders and chronic liver diseases increased. The highest observed-to-expected ratios were seen for alcohol use disorders for YLLs, neonatal sepsis for YLDs, and falls for DALYs (3.21, 2.65, and 2.03, respectively). CONCLUSIONS There was relatively little geographical variation in premature death and disability in CE in 2017, although some between-country differences existed. Health in Poland has been improving since 1990; in 2017 Poland outperformed CE as a whole for YLLs, YLDs, and DALYs. While the health gap between Poland and Western Europe has diminished, it remains substantial. The shift to NCDs and chronic disability, together with marked between-gender health inequalities, poses a challenge for the Polish health-care system. IHD is still the leading cause of disease burden in Poland, but DALYs from IHD are declining. To further reduce disease burden, an integrated response focused on NCDs and population groups with disproportionally high burden is needed.
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Affiliation(s)
- Maria Gańczak
- Department of Infectious Diseases, Institute of Medical Sciences, Zielona Góra University, Zielona Góra, Poland
| | - Tomasz Miazgowski
- Department of Propedeutics of Internal Diseases, Pomeranian Medical University, Szczecin, Poland
| | - Marta Kożybska
- Department of Medical Law of the Social Medicine Chair, Pomeranian Medical University in Szczecin, Faculty of Health Sciences, Szczecin, Poland
| | - Artur Kotwas
- Department of Public Health, Pomeranian Medical University, Faculty of Health Sciences, Szczecin, Poland
| | - Marcin Korzeń
- Department of Methods of Artificial Intelligence and Applied Mathematics, West Pomeranian University of Technology, Szczecin, Poland
| | - Bartosz Rudnicki
- Healthcare Management and Administration, Faculty of Health Sciences, Pomeranian Medical University, Szczecin, Poland
| | - Tomasz Nogal
- Healthcare Management and Administration, Faculty of Health Sciences, Pomeranian Medical University, Szczecin, Poland
| | | | - Marcel Ausloos
- School of Business, University of Leicester, Leicester, England, United Kingdom
- Department of Statistics and Econometrics, Bucharest University of Economic Studies, Bucharest, Romania
| | - Maciej Banach
- Department of Hypertension, Medical University of Lodz, Lodz, Poland
- Mothers’ Memorial Hospital Research Institute, Lodz, Poland
| | - Alexandra Brazinova
- Institute of Epidemiology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Maria-Magdalena Constantin
- IInd Department of Dermatology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- IInd Department of Dermatology, Colentina Clinical Hospital, Bucharest, Romania
| | | | - Claudiu Herteliu
- Department of Statistics and Econometrics, Bucharest University of Economic Studies, Bucharest, Romania
| | - Mihaela Hostiuc
- Department of General Surgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of Internal Medicine, Bucharest Emergency Hospital, Bucharest, Romania
| | - Sorin Hostiuc
- Department of Legal Medicine and Bioethics, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of Clinical Legal Medicine, National Institute of Legal Medicine Mina Minovici, Bucharest, Romania
| | - Mihajlo Jakovljevic
- N.A. Semashko Department of Public Health and Healthcare, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Jacek Jerzy Jozwiak
- Department of Family Medicine and Public Health, University of Opole, Opole, Poland
- Faculty of Medicine and Health Sciences, University of Opole, Opole, Poland
| | | | - Zbigniew J. Król
- Data and Analyses Department, Ministry of Health, Warsaw, Poland
| | - Tomislav Mestrovic
- Clinical Microbiology and Parasitology Unit, Dr. Zora Profozic Polyclinic, Zagreb, Croatia
- University Centre Varazdin, University North, Varazdin, Croatia
| | - Bartosz Miazgowski
- Center for Innovation in Medical Education, Pomeranian Medical University, Szczecin, Poland
| | - Neda Milevska Kostova
- Department of Health Policy and Management, Centre for Regional Policy Research and Cooperation ‘Studiorum’, Skopje, Macedonia
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United States of America
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, United States of America
| | - Ionut Negoi
- Department of General Surgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- General Surgery Department, Emergency Hospital of Bucharest, Bucharest, Romania
| | - Ruxandra Irina Negoi
- Anatomy and Embryology Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of Cardiology, Cardio-Aid, Bucharest, Romania
| | - Adrian Pana
- Department of Statistics and Econometrics, Bucharest University of Economic Studies, Bucharest, Romania
- Department of Health Outcomes, Center for Health Outcomes & Evaluation, Bucharest, Romania
| | - Salvatore Rubino
- Department of Biomedical Sciences, Università degli Studi di Sassari, Sassari, Italy
| | - Mario Sekerija
- Department of Medical Statistics, Epidemiology and Medical Informatics, School of Medicine, University of Zagreb, Zagreb, Croatia
- Croatian Institute of Public Health, Zagreb, Croatia
| | - Radoslaw Sierpinski
- Polish Medical Research Agency, Warsaw, Poland
- Department of Arrhythmias, Cardinal Wyszynski National Institute of Cardiology, Warsaw, Poland
| | | | - Roman Topor-Madry
- Institute of Public Health, Jagiellonian University Medical College, Krakow, Poland
- Agency for Health Technology Assessment and Tariff System, Warsaw, Poland
| | | | - Justyna Widecka
- Zdroje Hospital, Pomeranian Medical University, Szczecin, Poland
| | | | - Bogdan Wojtyniak
- Department of Population Health Monitoring and Analysis, National Institute of Public Health, Warsaw, Poland
| | - Vesna Zadnik
- Epidemiology and Cancer Registry Sector, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Jacek A. Kopec
- University of British Columbia, Vancouver, BC, Canada
- Arthritis Research Canada, Richmond, BC, Canada
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Zhang F, Finkelstein J. Inconsistency in race and ethnic classification in pharmacogenetics studies and its potential clinical implications. PHARMACOGENOMICS & PERSONALIZED MEDICINE 2019; 12:107-123. [PMID: 31308725 PMCID: PMC6612983 DOI: 10.2147/pgpm.s207449] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 05/30/2019] [Indexed: 12/11/2022]
Abstract
Introduction Racial and ethnic categories are frequently used in pharmacogenetics literature to stratify patients; however, these categories can be inconsistent across different studies. To address the ongoing debate on the applicability of traditional concepts of race and ethnicity in the context of precision medicine, we aimed to review the application of current racial and ethnic categories in pharmacogenetics and its potential impact on clinical care. Methods One hundred and three total pharmacogenetics papers involving the CYP2C9, CYP2C19, and CYP2D6 genes were analyzed for their country of origin, racial, and ethnic categories used, and allele frequency data. Correspondence between the major continental racial categories promulgated by National Institutes of Health (NIH) and those reported by the pharmacogenetics papers was evaluated. Results The racial and ethnic categories used in the papers we analyzed were highly heterogeneous. In total, we found 66 different racial and ethnic categories used which fall under the NIH race category “White”, 47 different racial and ethnic categories for “Asian”, and 62 different categories for “Black”. The number of categories used varied widely based on country of origin: Japan used the highest number of different categories for “White” with 17, Malaysia used the highest number for “Asian” with 24, and the US used the highest number for “Black” with 28. Significant variation in allele frequency between different ethnic subgroups was identified within 3 major continental racial categories. Conclusion Our analysis showed that racial and ethnic classification is highly inconsistent across different papers as well as between different countries. Evidence-based consensus is necessary for optimal use of self-identified race as well as geographical ancestry in pharmacogenetics. Common taxonomy of geographical ancestry which reflects specifics of particular countries and is accepted by the entire scientific community can facilitate reproducible pharmacogenetic research and clinical implementation of its results.
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Affiliation(s)
- Frederick Zhang
- Center for Bioinformatics and Data Analytics, Columbia University Irving Medical Center, New York, NY, USA
| | - Joseph Finkelstein
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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A Qualitative Study of What US Parents Say and Do When Their Young Children See Pornography. Acad Pediatr 2017; 17:844-849. [PMID: 28450081 DOI: 10.1016/j.acap.2017.04.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 04/12/2017] [Accepted: 04/15/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE There is no empirical information about how parents react when they discover that their young children have seen pornography. To address this gap in the literature, the current study sought to improve our understanding of parental reactions to discovering that their children ages <12 years old have seen pornography using a mixed-methods approach. METHODS A convenience sample of participants (N = 279) was recruited from the online survey service Mechanical Turk. Eligible participants completed an online survey comprising close-ended and open-ended questions about their reactions when their young children saw pornography. Qualitative data were analyzed using a content analysis approach. RESULTS Parents had 5 main reactions when realizing that their children had viewed pornography: 1) angry, shaming, or punitive; 2) calm and factual; 3) ignoring, minimizing, or denying that it happened; 4) panic or fear; and 5) lying to the child about what the child viewed. Most parents reacted calmly, while a small percentage reported that they hit, scolded, or shamed their young children for seeing the pornography. Many reported not knowing what to say or do. CONCLUSIONS Development and evaluation of parental scripts for developmentally appropriate parent-child (or pediatrician-child) communication about pornography could benefit the field.
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Altice FL, Azbel L, Stone J, Brooks-Pollock E, Smyrnov P, Dvoriak S, Taxman FS, El-Bassel N, Martin NK, Booth R, Stöver H, Dolan K, Vickerman P. The perfect storm: incarceration and the high-risk environment perpetuating transmission of HIV, hepatitis C virus, and tuberculosis in Eastern Europe and Central Asia. Lancet 2016; 388:1228-48. [PMID: 27427455 PMCID: PMC5087988 DOI: 10.1016/s0140-6736(16)30856-x] [Citation(s) in RCA: 172] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Despite global reductions in HIV incidence and mortality, the 15 UNAIDS-designated countries of Eastern Europe and Central Asia (EECA) that gained independence from the Soviet Union in 1991 constitute the only region where both continue to rise. HIV transmission in EECA is fuelled primarily by injection of opioids, with harsh criminalisation of drug use that has resulted in extraordinarily high levels of incarceration. Consequently, people who inject drugs, including those with HIV, hepatitis C virus, and tuberculosis, are concentrated within prisons. Evidence-based primary and secondary prevention of HIV using opioid agonist therapies such as methadone and buprenorphine is available in prisons in only a handful of EECA countries (methadone or buprenorphine in five countries and needle and syringe programmes in three countries), with none of them meeting recommended coverage levels. Similarly, antiretroviral therapy coverage, especially among people who inject drugs, is markedly under-scaled. Russia completely bans opioid agonist therapies and does not support needle and syringe programmes-with neither available in prisons-despite the country's high incarceration rate and having the largest burden of people with HIV who inject drugs in the region. Mathematical modelling for Ukraine suggests that high levels of incarceration in EECA countries facilitate HIV transmission among people who inject drugs, with 28-55% of all new HIV infections over the next 15 years predicted to be attributable to heightened HIV transmission risk among currently or previously incarcerated people who inject drugs. Scaling up of opioid agonist therapies within prisons and maintaining treatment after release would yield the greatest HIV transmission reduction in people who inject drugs. Additional analyses also suggest that at least 6% of all incident tuberculosis cases, and 75% of incident tuberculosis cases in people who inject drugs are due to incarceration. Interventions that reduce incarceration itself and effectively intervene with prisoners to screen, diagnose, and treat addiction and HIV, hepatitis C virus, and tuberculosis are urgently needed to stem the multiple overlapping epidemics concentrated in prisons.
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Affiliation(s)
- Frederick L Altice
- School of Medicine and School Public Health, Yale University, New Haven, CT, USA.
| | - Lyuba Azbel
- Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Jack Stone
- School of Social and Community Medicine, Bristol University, Bristol, UK
| | | | - Pavlo Smyrnov
- ICF International Alliance for Public Health, Kiev, Ukraine
| | - Sergii Dvoriak
- Ukrainian Institute on Public Health Policy, Kiev, Ukraine
| | - Faye S Taxman
- Department of Criminology, Law and Society, George Mason University, Fairfax, VA, USA
| | | | - Natasha K Martin
- School of Social and Community Medicine, Bristol University, Bristol, UK; Division of Global Public Health, University of California San Diego, San Diego, CA, USA
| | - Robert Booth
- Department of Psychiatry, University of Colorado, Denver, CO, USA
| | - Heino Stöver
- Institute of Addiction Research, Frankfurt University of Applied Sciences, Frankfurt, Germany
| | - Kate Dolan
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Peter Vickerman
- School of Social and Community Medicine, Bristol University, Bristol, UK
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Ten-Year Changes in the Prevalence and Socio-Demographic Determinants of Physical Activity among Polish Adults Aged 20 to 74 Years. Results of the National Multicenter Health Surveys WOBASZ (2003-2005) and WOBASZ II (2013-2014). PLoS One 2016; 11:e0156766. [PMID: 27272130 PMCID: PMC4896475 DOI: 10.1371/journal.pone.0156766] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 05/19/2016] [Indexed: 11/19/2022] Open
Abstract
Introduction The aim of the study was to estimate ten-year changes in physical activity (PA) patterns and sociodemographic determinants among adult residents of Poland. Methods The study comprised two independent samples of randomly selected adults aged 20–74 years participating in the National Multicentre Health Survey WOBASZ (2003–2005; n = 14572) and WOBASZ II (2013–2014; n = 5694). In both surveys the measurements were performed by six academic centers in all 16 voivodships of Poland (108 measurement points in each survey). Sociodemographic data were collected by an interviewer-administered questionnaire in both surveys. Physical activity was assessed in three domains: leisure-time, occupational and commuting physical activity. Results Leisure-time PA changed substantially between the surveys (p<0.001). The prevalence of subjects being active on most days of week fell in both genders in the years 2003–2014 (37.4% vs 27.3% in men); 32.7% vs 28.3% in women. None or occasional activity increased from 49.6% to 56.8% in men, while remained stable in women (55.2% vs 54.9%). In both WOBASZ surveys the likelihood of physical inactivity was higher in less educated individuals, smokers and those living in large agglomerations (p<0.01). No significant changes were observed in occupational activity in men between the surveys, while in women percentage of sedentary work increased from 43.4% to % 49.4% (p<0.01). Commuting PA decreased significantly in both genders (p<0.001). About 79.3% of men and 71.3% of women reported no active commuting in the WOBASZ II survey. Conclusions The observed unfavourable changes in PA emphasize the need for novel intervention concepts in order to reverse this direction. Further detailed monitoring of PA patterns in Poland is of particular importance.
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Hamrik Z, Sigmundová D, Kalman M, Pavelka J, Sigmund E. Physical activity and sedentary behaviour in Czech adults: results from the GPAQ study. Eur J Sport Sci 2013; 14:193-8. [PMID: 23889330 PMCID: PMC3935222 DOI: 10.1080/17461391.2013.822565] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The levels of physical activity (PA) and sedentary behaviour are significant indicators of health behaviour and their monitoring is crucial in developing public policy in the area of health promotion and non-communicable disease prevention. The aim of the study was to describe the prevalence of PA and sedentary behaviour as well as age and gender differences in Czech adults (18–90 years old, N = 1753; 48.4% male) participating in the Global Physical Activity Questionnaire (GPAQ) cross-sectional study 2011. To assess the significant differences between self-reported PA and sedentary behaviour the MANOVA, a post hoc Fischer's least significant difference (LSD) test and logistic regression were used. The level of PA was classified according to the amount of MET-minutes per week as high, moderate or low. Irrespective of age and gender, 32.3% of adults reported a low level of PA; 21.3% of adults fell within the category of moderate level of PA and 46.4% of adults reported a high level of PA. The level of PA decreases with age; men are generally more physically active than women. More than 60% of adults across all age categories are assessed as ‘sedentary’. The highest rate of sedentary behaviour was observed in adults over 65 years of age. The development of national strategies for PA promotion together with the development and verification of specific intervention programmes, especially for women, should be a priority in the Czech Republic.
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Affiliation(s)
- Zdenek Hamrik
- a Department of Recreation and Leisure Studies, Faculty of Physical Culture , Palacky University in Olomouc , Olomouc , Czech Republic
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