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M McKee

Publications and source records attributed to M McKee.

245 records · Page 14Linked to original sources
PubMedDate not supplied

Untangling Gordian knots: improving tuberculosis control through the development of 'programme theories'.

We argue that if the lessons from tuberculosis control programmes are to be drawn effectively then a more nuanced understanding is needed that takes account of the complex health system environment within which they sit. We suggest that a conceptual framework that draws upon the World Health Organization's DOTS strategy can be harnessed to assist the systematic analysis of programmes in a way that links this vertical, disease specific strategy to horizontal health system factors so that comparisons can be made. This multi-disciplinary, multi-method approach to the evaluation builds upon the work of others including Pawson and Tilley and their 'programmes theories'. This work has informed the application of an evaluation toolkit which has been successfully applied in a number of settings and assisted in the sustainable implementation of a DOTS strategy in Russia.

Directly Observed Therapy↗
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Changes in synaptosomal pH and rates of oxygen radical formation induced by chlordecone.

The resting pH of 7.14 +/- 0.02 within rat cortical synaptosomes is elevated in vitro by the insecticide chlordecone, in a dose-dependent manner. Chlordecone also reduces the rate of oxygen radical formation within synaptosomes. Both of these changes can also be demonstrated following in vivo treatment of rats with chlordecone (75 mg/kg body wt). Although chlordecone increases the permeability of the plasma membrane, the increase in pH observed is unlikely to be caused by this, since in vivo administration of chlordecone does not appreciably alter membrane order as evaluated by both a lipophilic probe, and a probe with an ionic segment. Another xenobiotic agent, methyl mercuric chloride, and a free radical generating system, an ascorbic acid-ferrous sulfate mixture, did not modulate synaptosomal pH, although membrane permeability was increased. Other evidence of the ability of synaptosomes to maintain homeostasis was the failure of mitochondrial inhibitors to significantly reduce pH. The drop in synaptosomal pH effected by amiloride, an inhibitor of Na+/H+ exchange, and the transient rise in pH caused by ammonium chloride further suggested that synaptosomes may be a good model in the study of the regulation of intracellular pH. The elevation of cytosolic pH, and depression of oxygen radical formation by chlordecone, may result from both the attenuation of respiratory metabolism and an impaired capacity of the plasma membrane to maintain ionic gradients.

Amiloride↗
PubMedDate not supplied

Patterns of alcohol consumption in Bulgaria.

Alcohol is increasingly being recognized as a major cause of the greater burden of disease and premature death in eastern Europe than in the west. This requires a robust policy response but, in most countries in the region, there is little empirical data on patterns of consumption on which to base such a response. Until now, there has been no information on prevalence of drinking among the Bulgarian population. This paper describes a survey that seeks to address this weakness by describing the pattern of drinking in Bulgaria and its relationship with socio-demographic factors. It uses a multivariate analysis of data on patterns of alcohol consumption from a multi-stage nationwide survey of 1550 adults in Bulgaria, in 1997 which found that overall 50.7% of men and 13.6% of women drink at least weekly. In both sexes, drinking is least common among the elderly and those living in villages. It is also less common among those reporting their financial status as poor. Muslims are less likely to drink than are orthodox Christians. Drinking is most common among those living in cities, with higher education and high incomes. Heavy drinking, defined as 80 g/day or more, is rare among women, but is ascribed to 18.2% of men. Heavy drinking was much more common among men living in Sofia and was less common among those whose financial situation was poor. At the levels of drinking reported, it can be expected that alcohol is making a substantial contribution to the burden of disease and premature mortality in Bulgaria. A coordinated, effective policy response is required. Although some of the legal prerequisites are in place, they are poorly enforced and there is no overall strategy to address this issue.

Adolescent↗
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Alcohol in Russia.

The contribution that alcohol has made to the large fluctuations in mortality in Russia in recent years is now widely recognized. An association between heavy drinking and Russia is part of popular culture. But what is the reality? This paper reviews the evidence on historical patterns of consumption in Russia, highlighting the difficulties of obtaining valid statistics during the Soviet period (1917-1991). It notes how the state, at various times, encouraged alcohol sales. By the early 1980s, the social cost of heavy drinking was becoming apparent. This led, in 1985, to the imposition of the wide-ranging and initially highly effective anti-alcohol campaign by Mikhail Gorbachev. The features of this campaign and of its subsequent collapse are described. In the 1990s, consumption of alcohol increased rapidly. There has, however, been a recent reduction in alcohol-related deaths. It is concluded that heavy drinking is not an inevitable feature of Russian life and that, as the state has done much to create the present problem, it also has a role to play in resolving it.

Adult↗
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Problem drinking among hospitalized patients in Hungary.

Alcohol is an important determinant of the overall burden of disease in Eastern Europe. It is a particularly important problem in Hungary, where death rates from cirrhosis have increased rapidly to levels much higher than in neighbouring countries. This study sought to describe the prevalence of problem drinking among the hospitalized population in Hungary by means of a survey of self-reported alcohol consumption and of the prevalence of current or lifetime problem drinking among hospitalized patients in the four teaching hospitals in Hungary. A survey was conducted of all patients (n = 3140) admitted to medical, surgical, trauma, psychiatric and neurological wards over a 2-week period in 1997 who stayed in hospital for at least 24 h, using a survey instrument based on the Alcohol Use Disorders Identification Test (AUDIT) and Luebeck Alcoholism Screening Test (LAST) instruments designed to screen for current and lifetime problem drinking respectively. In all, 23.5% of men and over 53.5% of women reported never drinking alcohol. Of those who did drink, about one in eight men and less than 1% of women reported drinking 5 or more drinks on a day when they drank. Whether defined by LAST or AUDIT, the prevalence of problem drinking was approximately 19% among men and 2% among women, although this rose to 32-35% among men aged 35-44 years. The rate did not vary significantly with employment or education, but was higher among those who were divorced. These high rates of problem drinking indicate the need for coherent policies on alcohol in Hungary.

Adult↗
PubMedDate not supplied

Down the road to deregulation.

A recent preliminary ruling by the European Court of Justice, that would have ended the Swedish state retail alcohol monopoly on grounds of European law on free movement of goods, highlights the international pressure on countries to deregulate further their alcohol markets. However, those countries that have recently taken the road to deregulation have not been able to prevent the alcohol industry encouraging people to drink more and they are experiencing increased alcohol-related problems. The international debates about tradeable commodities rarely take account of the consequences for public health. Alcohol is one such commodity that is also an important cause of premature death. It is essential that this is not overlooked in the race to promote free trade.

Alcohol Drinking↗
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Festive cheer for all?

Explore the source record for details and available documents.

Alcohol Drinking↗
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Ethical approval for health research in central and eastern Europe: an international survey.

UNLABELLED: Research ethics committees in central and eastern Europe are increasing in importance as institutions in this region host a growing and more diverse range and volume of health-related research, with funding from an increasingly wide variety of sources. AIM: To describe the arrangements for ethical supervision of research in eleven countries of central and eastern Europe, so as to identify examples of good practice and areas of weakness. METHODS: A questionnaire was sent to key informants known to be active in health-related research in Albania, Bulgaria, Croatia, Czech Republic, Estonia, Hungary, Lithuania, Poland, Romania, Russia, and Ukraine in October 2000. It sought information on the composition and functioning of ethics committees, their training and any public concerns about the ethics of health-related research. RESULTS: All countries except Ukraine confirmed that decision-making committee structures operate to oversee the ethics of research on human subjects. In all countries except Albania committees are comprised of medical and non-medical members. Members received specific training in bioethics in Estonia, Hungary, and Lithuania. Countries had made different degrees of progress in implementing arrangements for coordinating multi-site research and for monitoring research once it had commenced. Public concern about ethical issues arising from health-related research was rare. CONCLUSION: The development of ethical supervision of health-related research in central and eastern Europe varies considerably. In some countries there are significant weaknesses that should be addressed. Other countries could serve as examples of good practice in the region. A major challenge is how the public can be involved in this process.

Bioethics↗
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The changing role of the hospital in Europe: causes and consequences.

The United Kingdom, faced with a legacy of long-term under investment, has embarked on a major programme of hospital development. This raises many questions. What factors influence the work of the hospital? How can hospitals continue to adapt to changing circumstances? This paper draws on a recent study of the role of the hospital in Europe. It identifies major gaps in information about what hospitals do and how they are changing. International comparisons are especially difficult because of differences in definitions. The challenges that hospitals face can be categorised under three broad headings: the health needs of the population; opportunities and constraints they face in providing care; and the consequences of wider societal and economic factors that shape their environment. Health needs reflect the composition of the population (births, ageing, and migration), changes in risk factors, and changes in public expectations. Hospitals gain opportunities, but also face constraints as a result of changes in the workforce on which they draw and the technology that is available to them. They must also work within the constraints imposed by wider societal developments, such as the economy. Hospitals must also take account of their role as centres of teaching and research, as well as their responsibilities to the local community. Hospitals across Europe have changed considerably in the 1990s, with more people being admitted but staying for shorter periods. With the additional demands created by growing rates of day care and outpatients, hospitals are currently much busier places than in the past. There have also been considerable reconfigurations of hospitals in many countries. Some have been more successful in implementing change than others. Successful change is more likely where a whole system approach to health care is taken. Granting managerial autonomy to individual hospitals makes change less likely. Planning approaches are more successful than market-based ones. Change often requires construction of new facilities. The increasingly rapid pace of change in health care means that hospitals will have to adapt much more quickly than in the past. This will require a long-term programme of sustained and stable investment.

Europe↗