Energy poverty in the Energy Community region: Interrogating policy formulation and coverage

The capacity of the state to develop and implement policy at the complex nexus of energy infrastructure, social inequality and housing is indicative of the political priorities of governing structures and, by extension, the nature of statecraft more generally. We compare and contrast the energy poverty amelioration policies of two former Yugoslav and two post-Soviet states located outside the European Union, but seeking to join its regulatory sphere - Serbia, Montenegro, Ukraine and Georgia - against the background of deep and persistent patterns of domestic energy hardship. We are particularly interested in uncovering the time horizons, socio-technical systems and target constituencies of different policy measures, as well as energy sector-specific responses to the COVID-19 pandemic. We find that most states in the region have done little to address some of the more substantive challenges around improving housing quality, energy efficiency and gender inequality. However, energy poverty is present in the policy lexicon of all case study countries, and Ukraine, in particular, has advanced a number of more sophisticated approaches and programmes.

Self-efficacy and knowledge in pediatrics among family medicine physicians in Armenia: A survey study

Background

Armenia has trained physicians to practice family medicine (FM) for over 20 years. The pediatric population comprises a significant proportion of patients seen by FM practices, yet to date, there have been no studies assessing the knowledge and self-efficacy of FM physicians regarding pediatric care. As the first step is needs assessment to improve the quality of care, this study aims to assess the self-efficacy and knowledge of FM physicians regarding the care of pediatric patients.

Materials and Methods

We distributed a survey to attendees at an FM conference in Lori Province, Armenia. The survey instrument assessed demographics and experience, self-efficacy in providing pediatric care, and pediatric knowledge via questions adapted from the American Board of Family Medicine (ABFM).

Results

Eighty-seven percent of participants were female. Roughly half (45%) had trained through an FM residency program, while the remainder had retrained to become FM physicians following a residency in another field. Almost all (97%) practiced outside of the capital city, Yerevan. About half believed that their didactic (51%) and clinical education (48%) prepared them either "extremely" or "very" well. Overall, there was no clear relationship between participants' reported self-efficacy in a given area of pediatrics and their score in that area on the knowledge portion of the survey.

Conclusions

Our findings reveal opportunities for improvement in knowledge related to pediatric care in FM physicians in Armenia, as well as a lack of relationship between reported self-efficacy and knowledge. Thus, future programs should not rely solely on self-reported gaps to identify or prioritize areas of focus. Further study is recommended in other specialties in Armenia and internationally to improve future programs.

[Beginning of foreign exchange of acupuncture-moxibustion in New China: the whole story of the experts from the former Soviet Union studying acupuncture-moxibustion in China in 1956]

Through checking the archives from China Academy of Chinese Medical Sciences (CACMS), the event that the experts from the former Soviet Union visiting China and learning acupuncture-moxibustion in 1956 was sorted out. In 1956, under the framework of Sino-Sovien Agreement on Scientific and Technology Cooperation, 3 medical experts assigned by the former Soviet Union came to China for the investigation and study of acupuncture-moxibustion. Institute of Acupuncture and Moxibustion, CACMS was in charge of this activity at that time. The Institute had developed a detailed plan, in which, the teaching schedule was designed on the base of New Acupuncture and Moxibustion written by ZHU Lian and ZHU Lian herself gave the lecture. After 3-month study, the experts had mastered the basic theory and clinical techniques of acupuncture-moxibustion and had launched the relevant clinical and scientific work of acupuncture-moxibustion successfully after returning to their country. This event opens up the foreign exchange of acupuncture-moxibustion in New China and provides the foundation for international training and higher education of acupuncture-moxibustion thereafter.

The Incidence of Intestinal Gastric Cancer among Resettlers in Germany-Do Resettlers Remain at an Elevated Risk in Comparison to the General Population?

Objective: Previous studies have shown that the incidence of gastric cancer (GC), and particularly intestinal GC, is higher among resettlers from the former Soviet Union (FSU) than in the general German population. Our aim was to investigate if the higher risk remains over time. Methods: GC cases between 1994 and 2013, in a cohort of 32,972 resettlers, were identified by the respective federal cancer registry. Age-standardized rates (ASRs) and standardized incidence ratios (SIRs) were analyzed in comparison to the general population for GC subtypes according to the Laurén classification. Additionally, the cohort was pooled with data from a second resettler cohort from Saarland to investigate time trends using negative binomial regression. Results: The incidence of intestinal GC was elevated among resettlers in comparison to the general population (SIR (men) 1.64, 95% CI: 1.09–2.37; SIR (women) 1.91, 95% CI: 1.15–2.98). The analysis with the pooled data confirmed an elevated SIR, which was stable over time. Conclusion: Resettlers’ higher risk of developing intestinal GC does not attenuate towards the incidence in the general German population. Dietary and lifestyle patterns might amplify the risk of GC, and we believe that further investigation of risk behaviors is needed to better understand the development of disease pattern among migrants.

Knowledge and attitudes about mental health among older immigrants from the former Soviet Union to Israel and their primary care physicians

Previous studies have documented a high prevalence of psychological distress and mental illness among older immigrants from the former Soviet Union (FSU) in Israel. Yet, this population rarely seeks help from mental health providers. The present study aimed to identify beliefs and attitudes about depression and anxiety among older immigrants from the FSU treated in primary care, and among their primary care physicians, who were also FSU immigrants. The study used focus group (FG) interviews with primary care patients (n = 12) and physicians (n = 23). The interviews were transcribed and analyzed using open thematic coding. Three main themes were identified: a) avoidance of discussion of mental health and stigma regarding mental illness; b) expectations to control one's mental state; and c) limited opportunities to acquire knowledge about Western mental health. Primary care physicians recognized the barriers facing their older immigrant patients concerning mental health diagnosis and treatment. Yet, due to work overload, their ability to assist older immigrants was limited. The findings suggest that older immigrants from the FSU might benefit from mental health information and exchange of ideas about Western mental health.

Male labor migration, patriarchy, and the awareness-behavior gap: HIV risks and prevention among migrants' wives in Armenia

Unlike in most of the world, HIV incidence in the former Soviet Union continues to rise. While international labor migration has been identified as a potentially important contributor to this trend, most attention has been focused on risks of male migrants themselves. This study uses recent household survey data to examine HIV-related perceptions and actions of migrants' left-behind wives in Armenia. Multivariate logistic regression analyses show that migrants' wives are significantly more likely to suspect their husbands of extramarital sex than are non-migrants' wives. The analyses detect greater worries about HIV infection and a higher likelihood of spousal communication on HIV matters among migrants' wives, compared to non-migrants' wives, but these differences are largely explained by the suspicion of husband's extramarital sex. Finally, no difference between the two categories of women in the probability of consistent condom use with husbands is found. These findings are interpreted within the context of patriarchal culture and unequal gender relations in Armenian society as they are further reinforced by male migration. Implications of these findings for policies to increase women's awareness of HIV risks associated with migration and their ability to reduce those risks are discussed.

Socio-demographic predictors of sleep complaints in indigenous Siberians with a mixed economy

OBJECTIVES

Socio-demographic indicators closely relate to sleep in industrialized populations. However we know very little about how such factors impact sleep in populations undergoing industrialization. Within populations transitioning to the global economy, the preliminary evidence has found an inconsistent relationship between socio-demographics and sleep complaints across countries and social strata.

MATERIALS AND METHODS

Surveys were conducted on a sample of rural Sakha (Yakut) adults (n = 168) during the autumn of 2103 to assess variation in socio-demographics and sleep complaints, including trouble sleeping and daytime sleepiness. Socio-demographic variables included age, gender, socioeconomic measures, and markers of traditional/market-based lifestyle. We tested whether the socio-demographic variables predicted sleep complaints using bivariate analyses and multiple logistic regressions.

RESULTS

Trouble sleeping was reported by 18.5% of the participants and excessive daytime sleepiness (EDS) by 17.3%. Trouble sleeping was significantly predicted by older age, female gender, and mixing traditional and market-based lifestyles. EDS was not significantly predicted by any socio-demographic variable.

DISCUSSION

These findings support the few large-scale studies that found inconsistent relationships between measures of socioeconomic status and sleep complaints in transitioning populations. Employing a mix of traditional and market-based lifestyles may leave Sakha in a space of vulnerability, leading to trouble sleeping.

Fruit and vegetable consumption and mortality in Eastern Europe: Longitudinal results from the Health, Alcohol and Psychosocial Factors in Eastern Europe study

BACKGROUND

It is estimated that disease burden due to low fruit and vegetable consumption is higher in Central and Eastern Europe (CEE) and the former Soviet Union (FSU) than any other parts of the world. However, no large scale studies have investigated the association between fruit and vegetable (F&V) intake and mortality in these regions yet.

DESIGN

The Health, Alcohol and Psychosocial Factors in Eastern Europe (HAPIEE) study is a prospective cohort study with participants recruited from the Czech Republic, Poland and Russia.

METHODS

Dietary data was collected using food frequency questionnaire. Mortality data was ascertained through linkage with death registers. Multivariable adjusted hazard ratios were calculated by Cox regression models.

RESULTS

Among 19,333 disease-free participants at baseline, 1314 died over the mean follow-up of 7.1 years. After multivariable adjustment, we found statistically significant inverse association between cohort-specific quartiles of F&V intake and stroke mortality: the highest vs lowest quartile hazard ratio (HR) was 0.52 (95% confidence interval (CI): 0.28-0.98). For total mortality, significant interaction (p = 0.008) between F&V intake and smoking was found. The associations were statistically significant in smokers, with HR 0.70 (0.53-0.91, p for trend: 0.011) for total mortality, and 0.62 (0.40-0.97, p for trend: 0.037) for cardiovascular disease (CVD) mortality. The association was appeared to be mediated by blood pressure, and F&V intake explained a considerable proportion of the mortality differences between the Czech and Russian cohorts.

CONCLUSIONS

Our results suggest that increasing F&V intake may reduce CVD mortality in CEE and FSU, particularly among smokers and hypertensive individuals.

The mothering experiences of sex-trafficked women: between here and there

This qualitative study focuses on the mothering experiences of women from the former Soviet Union (FSU) who were sex-trafficked to Israel. In-depth interviews were conducted with 8 women who gave birth either in the FSU or in Israel. The women's stories reflect 3 experiential spheres, those of "the good mother," "the sacrificing mother," and "the mother who wants for herself." These mothering spheres were found to exist against the backdrop of a life between 2 countries, where the women's mothering is split between "here" and "there." Furthermore, it was found that the women's sex-trafficking experience continually threatened to invade the 3 mothering spheres and destabilize the balance among them. The splits and conflicts among the mothering spheres are examined from a gendered perspective with emphasis on mother-daughter relationships and on the social constructions of mothering and prostitution.

Waste management and recycling in the former Soviet Union: the City of Bishkek, Kyrgyz Republic (Kyrgyzstan)

The UN-Habitat Integrated Sustainable Waste Management (ISWM) benchmarking methodology was applied to profile the physical and governance features of municipal solid waste (MSW) management in the former Soviet Union city of Bishkek, capital of the Kyrgyz Republic. Most of the ISWM indicators were in the expected range for a low-income city when compared with 20 reference cities. Approximately 240,000 t yr(-1) of MSW is generated in Bishkek (equivalent to 200 kg capita(-1) yr(-1)); collection coverage is over 80% and 90% of waste disposed goes to semi-controlled sites operating with minimal environmental standards. The waste composition was a distinctive feature, with relatively high paper content (20-27% wt.) and intermediate organic content (30-40% wt.). The study provides the first quantitative estimates of informal sector recycling, which is currently unrecognised by the city authorities. Approximately 18% wt. of generated MSW is recycled, representing an estimated annual saving to the city authorities of US$0.7-1.1 million in avoided collection/disposal costs. The waste management system is controlled by a centralised municipal waste enterprise (Tazalyk); therefore, institutional coherence is high relative to lower-middle and low-income cities. However, performance on other governance factors, such as inclusivity and financial sustainability, is variable. Future priorities in Bishkek include extending collection to unserved communities; improving landfill standards; increasing recycling rates through informal sector cooperation; improving data availability; and engaging all stakeholders in waste management strategy decisions. Extending the scope and flexibility of the ISWM protocol is recommended to better represent the variation in conditions that occur in waste management systems in practice.

Has global fund support for civil society advocacy in the former Soviet Union established meaningful engagement or 'a lot of jabber about nothing'?

Although civil society advocacy for health issues such as HIV transmission through injecting drug use is higher on the global health agenda than previously, its impact on national policy reform has been limited. In this paper we seek to understand why this is the case through an examination of civil society advocacy efforts to reform HIV/AIDS and drugs-related policies and their implementation in three former Soviet Union countries. In-depth semi-structured interviews were conducted in Georgia, Kyrgyzstan and Ukraine by national researchers with representatives from a sample of 49 civil society organizations (CSOs) and 22 national key informants. We found that Global Fund support resulted in the professionalization of CSOs, which increased confidence from government and increased CSO influence on policies relating to HIV/AIDS and illicit drugs. Interviewees also reported that the amount of funding for advocacy from the Global Fund was insufficient, indirect and often interrupted. CSOs were often in competition for Global Fund support, which caused resentment and limited collective action, further weakening capacity for effective advocacy.