326 research outputs found
An analysis of trends and determinants of health insurance and healthcare utilisation in the Russian population between 2000 and 2004: the 'inverse care law' in action.
No full textBACKGROUND: The break-up of the USSR brought considerable disruption to health services in Russia. The uptake of compulsory health insurance rose rapidly after its introduction in 1993. However, by 2000 coverage was still incomplete, especially amongst the disadvantaged. By this time, however, the state health service had become more stable, and the private sector was growing. This paper describes subsequent trends and determinants of healthcare insurance coverage in Russia, and its relationship with health service utilisation, as well as the role of the private sector. METHODS: Data were from the Russia Longitudinal Monitoring Survey, an annual household panel survey (2000-4) from 38 centres across the Russian Federation. Annual trends in insurance coverage were measured (2000-4). Cross-sectional multivariate analyses of the determinants of health insurance and its relationship with health care utilisation were performed in working-age people (18-59 years) using 2004 data. RESULTS: Between 2000 and 2004, coverage by the compulsory insurance scheme increased from 88% to 94% of adults; however 10% of working-age men remained uninsured. Compulsory health insurance coverage was lower amongst the poor, unemployed, unhealthy and people outside the main cities. The uninsured were less likely to seek medical help for new health problems. 3% of respondents had supplementary (private) insurance, and rising utilisation of private healthcare was greatest amongst the more educated and wealthy. CONCLUSION: Despite high population insurance coverage, a multiply disadvantaged uninsured minority remains, with low utilisation of health services. Universal insurance could therefore increase access, and potentially contribute to reducing avoidable healthcare-related mortality. Meanwhile, the socioeconomically advantaged are turning increasingly to a growing private sector
Survival of Civilian and Prisoner Drug-Sensitive, Multi- and Extensive Drug- Resistant Tuberculosis Cohorts Prospectively Followed in Russia
No full textThis is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited
Rheumatic diseases and viral infection: is there an association?
No full textViral infections, hepatitis B and C and herpesvirus-induced infections in particular, are widespread in the population. Recent years have seen the emergence of new viral infections that were previously endemic. Understanding the role of viruses in the pathogenesis of rheumatic diseases (RDs) is of great importance. First, they cause the clinical manifestations characteristic of many RDs (systemic lupus erythematosus, rheumatoid arthritis, polymyositis, and Sjö gren's disease). The author discusses several possible mechanisms of the involvement of viruses in the development of autoimmune disorders: molecular mimicry; polyclonal B cell activation with overproduction of antibodies and immune complexes; T cell activation with cytokine overproduction. Secondly, viral infection can be reactivated during immunosuppressive therapy (also using biological agents), which is widely used to treat RDs. The review presents data on both the most common viruses (hepatitis B and C viruses, HIV, and human herpesviruses types 1–6) and more rare ones (chikungunya virus and polyomavirus) in the Russian population
Ekranizacije djela "Zapisi mladog liječnika" i "Morfij" M. A. Bulgakova
No full textDiplomski rad Ekranizacije djela „Zapisi mladog liječnika“ i „Morfij“ M. A. Bulgakova posvećen je analizi filma Записки юного врача (Zapiski junogo vrača) redatelja Mihaila Jakžena, filma Морфий (Morfij) redatelja Alekseja Balabanova i televizijskе serijе A Young Doctor's Notebook & Other Stories redatelja Alexa Hardcastlea. Sve tri ekranizacije temelje se na zbirci priča Zapisi mladog liječnika i pripovijesti Morfij. Navedena djela spadaju u Bulgakovljevu ranu prozu prožetu autobiografskim i medicinskim elementima. Ekranizacije su su se usredotočile na različite elemente iz Bulgakovljevih književnih djela i njegova života. Različitim postupcima prijenosa književnoga teksta u filmski narativ, nastale su tri posve različite ekranizacije istih djela: jedna pokušava što vjernije prenijeti izvornik na ekran jedna pokušava komentirati društveno stanje, a treća nastoji zabaviti publiku. Rad polazi od pretpostavke da je ekranizacija intersemiotički prijevod (R. Jakobson) te obiluje različitim teorijskim shvaćanjima suodnosa između književnog teksta i njegove filmske „inačice“ (U. Eco; O. Aronson; L. Nehorošev; N. Zorkaja; V. Mil'don i dr.)
BRICS' role in global health and the promotion of universal health coverage : the debate continues
No full textThe acronym BRIC was coined by Jim O’Neill, a senior executive at Goldman Sachs, to denote four emerging national economies: Brazil, the Russian Federation, India and China.
Although BRICS and other multinational groupings may be useful to policy-makers involved in the development of some foreign policies, it remains unclear if such groupings have a role in the study and development of global health policy. We examine the debate around this issue and focus on BRICS’ potential role in the promotion of universal health coverage – an “umbrella” goal for health in the post-2015 development framework.
We do not argue that BRICS has no value as a grouping. The constituent nations do have some things in common: they are all large, populous, diverse countries with many different ethnic, social and – in some cases – religious divisions. They share these characteristics with some other countries, such as Indonesia, Nigeria, Indonesia and Pakistan, that have made less progress toward universal health coverage but may be able to learn from BRICS’ experiences. There is no doubt that, in the promotion of universal health coverage, there is a need for collaboration and shared learning. However, a grouping of countries that may make sense in the coordination of global macroeconomic policy cannot be assumed to be relevant in the development of any global health policy
Interferon system in patients with rheumatoid arthritis infected with hepatitis В and С viruses
No full textInterferon system in patients with rheumatoid arthritis infected with hepatitis В and С viruses. R.M. Balabanova, E. V. Vratskih, T.P. Ospelnikova, V.l. Kiseleva Objective. To assess interferon (IFN) status state in pts with rheumatoid arthritis (RA) associated with hepatitis В and С viruses and cryoglobulinemia (CGM). Material and methods. IFN status was assessed in 74 pts with definite RA divided in 4 groups: infected with viruses of hepatitis С (HCV) and В (HBV) (respectively group 1 and 2), RA with CGM (group 3), RA without hepatitis В, С and CGM. IFN status indices were assessed with micromethod in hole heparinized blood. Results. Hepatitis viruses carriers (groups 1 and 2) had significantly elevated circulating IFN level and deep immunocytes IFN producing ability down regulation. In HBV+ RA pts and IFN production decrease was maximal (degree III), in HCV+ RA pts - weaker (degree II). Conclusion. IFN status examination in pts with RA associated with hepatitis viruses and CGM has not only theoretical but also practical importance. Actuality of further study of this problem is determined by necessity of appropriate treatment selection considering IFN system pathology
Action to protect the independence and integrity of global health research.
No full textStoreng KT, Abimbola S, Balabanova D, et al. Action to protect the independence and integrity of global health research. BMJ GLOBAL HEALTH. 2019;4(3): e001746
Prevalence and factors associated with the use of alternative (folk) medicine practitioners in 8 countries of the former Soviet Union.
No full textBACKGROUND: Research suggests that since the collapse of the Soviet Union there has been a sharp growth in the use of complementary and alternative medicine (CAM) in some former Soviet countries. However, as yet, comparatively little is known about the use of CAM in the countries throughout this region. Against this background, the aim of the current study was to determine the prevalence of using alternative (folk) medicine practitioners in eight countries of the former Soviet Union (fSU) and to examine factors associated with their use. METHODS: Data were obtained from the Living Conditions, Lifestyles and Health (LLH) survey undertaken in eight former Soviet countries (Armenia, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia and Ukraine) in 2001. In this nationally representative cross-sectional survey, 18428 respondents were asked about how they treated 10 symptoms, with options including the use of alternative (folk) medicine practitioners. Multivariate logistic regression analysis was used to determine the factors associated with the treatment of differing symptoms by such practitioners in these countries. RESULTS: The prevalence of using an alternative (folk) medicine practitioner for symptom treatment varied widely between countries, ranging from 3.5% in Armenia to 25.0% in Kyrgyzstan. For nearly every symptom, respondents living in rural locations were more likely to use an alternative (folk) medicine practitioner than urban residents. Greater wealth was also associated with using these practitioners, while distrust of doctors played a role in the treatment of some symptoms. CONCLUSIONS: The widespread use of alternative (folk) medicine practitioners in some fSU countries and the growth of this form of health care provision in the post-Soviet period in conditions of variable licensing and regulation, highlights the urgent need for more research on this phenomenon and its potential effects on population health in the countries in this region
Financing the health care system in Bulgaria : options and strategies.
No full textThe transition to democracy in 1989 forced the Bulgarian health system to change.
Falling government revenues and popular demand for a more transparent regime brought
pressure for a new system of financing.
The process of reform was slow and inconsistent. In part this reflected a lack of political
will but there was also an absence of relevant information on the consequences of
different options. This thesis seeks to fill this gap by means of an integrated series of
studies to analyse the previous system and evaluate the options for change. The research
uses literature review, documentary analysis, quantitative research (a population based
survey) and qualitative research (interviews and focus groups).
The research documents the scale of inequalities in health and health seeking behaviour.
Self reported health varies considerably. Utilisation is more evenly distributed, although
the poor access less care after allowance for their poorer health. They are also more
likely to be cared for in lower tiers in the system.
Informal transactions play an important role in the Bulgarian health care system. This has
two components. One is a traditional 'culture of gifts which typically imposes no more
than minor inconvenience and is not a prerequisite to receive care. A second has
appeared more recently. It compensates for genuine shortages and reductions in salaries
and does have an impact on access.
The existing financing system is regressive and hospital stays can incur considerable
expenditure. This is generally found from current income and there was little evidence of
ill health leading to impoverishment. This was, however, largely because of the
persistence of strong informal support mechanisms.
The introduction of social insurance is seen as a solution to the problems of the existing
system and receives widespread support, but it is poorly understood. The misconceptions
threaten its sustainability.
This thesis demonstrates how different methods can be integrated to evaluate a health
care financing system and provides important new insights into payment for health care
in countries in transition
Ревматические заболевания и вирусная инфекция: есть ли связь?
No full textViral infections, hepatitis B and C and herpesvirus-induced infections in particular, are widespread in the population. Recent years have seen the emergence of new viral infections that were previously endemic. Understanding the role of viruses in the pathogenesis of rheumatic diseases (RDs) is of great importance. First, they cause the clinical manifestations characteristic of many RDs (systemic lupus erythematosus, rheumatoid arthritis, polymyositis, and Sjö gren's disease). The author discusses several possible mechanisms of the involvement of viruses in the development of autoimmune disorders: molecular mimicry; polyclonal B cell activation with overproduction of antibodies and immune complexes; T cell activation with cytokine overproduction. Secondly, viral infection can be reactivated during immunosuppressive therapy (also using biological agents), which is widely used to treat RDs. The review presents data on both the most common viruses (hepatitis B and C viruses, HIV, and human herpesviruses types 1–6) and more rare ones (chikungunya virus and polyomavirus) in the Russian population.Вирусные инфекции, особенно гепатиты В и С и инфекции, вызванные герпесвирусами, широко распространены в популяции. В последние годы отмечается появление новых вирусных инфекций, ранее являвшихся эндемичными. Понимание роли вирусов в патогенезе ревматических заболеваний (РЗ) имеет большое значение. Во-первых, они вызывают клинические проявления, характерные для многих РЗ (системной красной волчанки, ревматоидного артрита, полимиозита, болезни Шёгрена). Обсуждается несколько возможных механизмов участия вирусов в развитии аутоиммунных нарушений: молекулярная мимикрия, поликлональная активация В-клеток с гиперпродукцией антител и иммунных комплексов, активация Т-клеток с гиперпродукцией цитокинов. Во-вторых, возможна реактивация вирусной инфекции на фоне иммуносупрессивной терапии (в том числе генно-инженерными биологическими препаратами), широко применяемой для лечения РЗ. В обзоре представлены данные как о самых распространенных (вирусы гепатита В и С, ВИЧ, герпесвирусы человека 1–6-го типов), так и более редких (вирус чукунгунья, полиомавирус) в российской популяции вирусах
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