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Biomedical subjects

M McKee

Publications and source records attributed to M McKee.

At least 109 records · Page 6Linked to original sources
PubMed1998

An analysis of alcohol policy in Hungary. Who is in charge?

AIM: In the light of unprecedented increases in the levels of chronic liver disease and cirrhosis in Hungary, accompanied by other evidence of increasing health and social consequences of alcohol, this study aimed to identify alcohol policy actors at the national level, describe their understanding of alcohol policy, determine their position, interest and influence on the issue, and identify the inter-relationships between these actors. METHODS: A series of interviews with key actors identified through a snowball technique, supplemented by a telephone survey of local government authorities. Analysis was undertaken according to the principles of stakeholder analysis and political mapping. FINDINGS AND CONCLUSIONS: The alcohol policy arena is fragmented. There is a lack of explicit and coherent goals and a shared vision by all actors is missing. Key actors do not seem to be aware of what they could do as a result of their position, and how. There is a failure to develop strategic alliances. Those actors with high and medium levels of support and interest in a comprehensive alcohol policy which would seek to control overall consumption have little influence. Those with influence in the policy arena have not mobilized themselves as regards public health in general and alcohol related policy in particular, with few notable exceptions. Considerable opposition can be expected from those working in retail and catering facilities.

Alcohol Drinking↗
PubMed1998

Zimbabwe's hospital referral system: does it work?

BACKGROUND: Anecdotal evidence has suggested inefficiency in the pyramidal health care referral system established in Zimbabwe in 1980, as part of its primary health care (PHC) model. AIM: To assess the functioning of the pyramidal referral system in two rural districts surrounding Harare, Zimbabwe, with regard to two common indicator conditions: pneumonia in children and malaria in adults. METHODS: For a three-month period, all complete inpatient records with discharge diagnoses of pneumonia or malaria from three hospitals representing different levels of care were analyzed (n = 227). Data were collected on demographic and patient care variables. The appropriateness of admissions and referrals was determined by an assessment of the severity of illness and 'intensiveness' of care required. Data were analyzed for differences among the three hospitals and between the two indicator conditions. Per night inpatient bed costs for each hospital were also calculated. RESULTS: For pneumonia in children, 56.8% of patients admitted at the secondary level, 53.8% of patients at the tertiary level and 57.8% of patients at the quaternary level were of mild severity. For malaria in adults, 74.0% of patients seen at the secondary level, 81.5% of patients at the tertiary level and 54.3% at the quaternary level were of mild severity. For pneumonia, were no differences in severity between the three hospitals whereas for malaria significant case-mix differences among the hospitals were found. Most patients attending the highest level referral facility were inappropriate admissions who could have been treated at a lower level of care. The majority of patients at all the hospitals studied had used that hospital as their first or second point of contact with the health services. There were large variations in the inpatient per night bed costs between the three hospitals. CONCLUSIONS: Using the indicator diseases of pneumonia in children and malaria in adults, this study concluded that this network did not meet design expectations as the central level referral hospital cared for a similar case-mix of patients as the district level, but at six times the cost. The appropriateness of admissions and referrals could be improved by developing or strengthening intermediate level facilities, by changing mechanisms of access to specialist facilities and by training health professionals in community settings.

Adult↗
PubMed1998

Seasonal variation in mortality in Moscow.

BACKGROUND: Seasonal variation in mortality has been investigated in many countries but not, until recently, in Russia. There are some grounds for suspecting that it may differ in Russia from what is seen in western countries. This paper explores patterns of seasonal variation in mortality in Moscow between 1993 and 1995. METHODS: Analysis was based on individual data on deaths occurring in Moscow between January 1993 and December 1995, grouped by four-week period and by calendar month and on mean monthly temperature in Moscow for the same period. Crude, smoothed and deseasonalized trends were inspected. Auto-correlation functions were estimated and deaths were regressed against temperature. RESULTS: As in other northern hemisphere countries, there is a winter excess of deaths but this is much smaller than in many western countries. It is restricted to some causes of death, such as ischaemic heart disease and cerebrovascular disease, and is associated with low temperature. In contrast, there is a marked summer increase in deaths among young people, especially from accidents and other deaths associated with alcohol consumption. Over the three-year period studied, there was an initial underlying increase in alcohol-related deaths that subsequently fell, coinciding with a previously observed increase in life expectancy. CONCLUSIONS: It is possible that the low level of excess winter mortality reflects warmer indoor environments than in the west. The seasonal variation of deaths among young people reinforces evidence of the important role of alcohol in the Russian mortality crisis.

Accidents↗
PubMed1998

Alcohol and cardiovascular mortality in Moscow; new evidence of a causal association.

BACKGROUND: In explaining recent trends in Russian mortality, alcohol drinking has often been put forward as a major factor. However, cardiovascular disease remains the major cause of death in Russia and alcohol is currently viewed as having a protective effect on heart disease. This study explores this apparent paradox by examining daily trends in deaths from cardiovascular disease in Moscow. SUBJECTS: Those dying in Moscow in the years 1993-1995. METHODS: Analysis of daily variation in deaths based on data from Moscow City death certificates. RESULTS: There is a significant increase in deaths from alcohol poisoning, accidents, and violence and cardiovascular diseases on Saturdays, Sundays, and Mondays. This is especially marked for sudden deaths. This pattern is consistent with the known pattern of drinking in Russia, which is more likely to take place in binges than is the case in other countries. CONCLUSION: A possible causative role for alcohol in sudden cardiovascular death is suggested as there are no other obvious explanations for this pattern, which cannot be accounted for by daily variations in traditional risk factors such as smoking or lipids. Although this is inconsistent with the prevailing view in the West that alcohol is seen as cardioprotective, there is considerable supporting evidence from a necropsy study and from studies in other places with a similar pattern of drinking. In countries such as Russia, where patterns of drinking differ considerably from that in the West, binge drinking can be an important cause of sudden cardiac death. This has important implications for estimates of the amount of mortality worldwide attributable to specific risk factors and thus for national and international policy.

Adult↗
PubMed1998

Patterns of smoking in Russia.

BACKGROUND: Tobacco is a leading cause of avoidable death in Russia but there is, as yet, relatively little information in the public domain on who is smoking and how this is changing. This information is important for those seeking to develop effective policies to tackle this issue. OBJECTIVE: To determine the prevalence of smoking in Russia and its association with sociodemographic factors. DESIGN: Cross-sectional survey on patterns of tobacco consumption. SETTING: Data were collected using the New Russia Barometer, a multi-stage stratified-sample survey of the population of the Russian Federation undertaken in the summer of 1996. PARTICIPANTS: Data were available on 1587 individuals (response rate 65.7%). Respondents differed little from the overall Russian population in terms of age, sex, education, and voting intention. MAIN OUTCOME MEASURES: Prevalence of current and past smoking. RESULTS: Smoking is common among males of all ages and in all areas. Of those aged 18-24 years, 65% smoke, rising to 73% in those aged 25-34 and then falling steadily to reach 41% in those aged 65 and older. Among women, smoking is much more common among the young (27% in those aged 18-34) than among the middle-aged and elderly (5% in those aged 55 and older), and more common among those living in urban areas than in rural areas. Smoking is also more common among men and women suffering material deprivation but there is no independent association with education. Among men, but not women, church attendance is inversely associated with smoking. In both sexes, but especially women, heavy drinking and smoking are associated. CONCLUSIONS: Tobacco poses a major threat to the health of future generations in Russia, especially among women. A robust policy response is required.

Adolescent↗
PubMed1998

Patterns of smoking in Bulgaria.

BACKGROUND: Although the rate of smoking-related deaths in Bulgaria is still relatively low, in international terms, it has been rising rapidly. This is likely to become worse in the future as Bulgaria faces growing pressure from transnational tobacco companies. There is, however, little information on patterns of smoking, which is necessary for development of effective policies to tackle tobacco consumption. OBJECTIVE: To describe the pattern of smoking in Bulgaria and its relationship with sociodemographic factors. DESIGN: Multivariate analysis of data on patterns of tobacco consumption from a multi-stage nationwide survey of 1550 adults. SETTING: Bulgaria, in 1997. MAIN OUTCOME MEASURE: Prevalence of current cigarette smoking. RESULTS: 38.4% of men and 16.7% of women smoke. Smoking rates are strongly associated with age, with 58% of men and 30% of women aged 30-39 smoking whereas only 5% of men aged 70 years and older and almost no women of this age smoke. Smoking is more common in cities, among those who are widowed or divorced, or who do not own their home. There is no clear association with household income or, for men, with education, although there is a suggestion that smoking may be more common among more highly educated women. CONCLUSIONS: The observed pattern of smoking indicates the need for a robust policy to tackle smoking in Bulgaria, especially among the young in large cities, informed by a better understanding of why smoking rates vary among different groups.

Adult↗
PubMed1998

The positive relationship between alcohol and heart disease in eastern Europe: potential physiological mechanisms.

Research into the effect of alcohol on cardiovascular disease has indicated protective effects from moderate consumption. These observations, made in industrialized countries, have influenced policies on alcohol in countries where the situation may be quite different--specifically, where consumption is substantially higher or patterns of drinking are different. In central and eastern Europe and the former Soviet Union, a growing body of epidemiological research indicates a positive rather than negative association between alcohol consumption and cardiovascular deaths, especially sudden cardiac deaths. By means of a systematic review of published work, we examine whether there is a physiological basis for the observed association between alcohol and heart disease seen in eastern Europe, focusing on the effects of high levels of consumption and of irregular or binge drinking. In binge drinkers, cardioprotective changes in high-density lipoproteins are not seen, and adverse changes in low-density lipoproteins are acquired. Irregular drinking is associated with an increased risk of thrombosis, occurring after cessation of drinking. It predisposes both to histological changes in the myocardium and conducting system and to a reduction in the threshold for ventricular fibrillation. Measures of frequency as well as quantity of consumption should be included in epidemiological studies. Taken with the epidemiological evidence emerging from eastern Europe, these observations have important implications for estimates of the burden of disease attributable to alcohol.

Alcohol Drinking↗
PubMed1998

The impact of managed care on clinical research.

Traditionally, US teaching hospitals have subsidised research by charging higher costs for treatment; however, this approach is being challenged. The growth of managed-care organisations, concerned about maximising profits, has led many to argue that clinical research will be damaged, whether by the loss of internal funds for research or by reductions in the numbers of patients available for studies. This review examines the evidence on which this argument is based. There is some evidence that managed-care organisations are refusing to cover patients who are involved in clinical trials, although, in general, they are receptive towards research providing that it is explicit and seen as relevant. The indirect effects of competition are, arguably, more important. Although many academic centres have established strategies to protect research funds, those working in the most competitive healthcare environments are obtaining fewer externally funded research grants. They are also publishing fewer papers and are working in climates that are seen as less supportive, with less ability to undertake research that is not externally funded. There is little evidence that managed care is reducing access to patients for clinical research. The growth of managed care is, together with certain other trends, also influencing the nature of clinical research. The overall consequences of these different factors are difficult to predict, although there are grounds for concern about recruitment and retention of junior researchers. The relationship between the various actors involved in healthcare and research is dynamic and, as pressure is excerpted in a particular direction, others adapt. It may be some time before the consequences of policies being enacted now are apparent.

Clinical Trials as Topic↗
PubMed1998

Neonatal mortality in the Czech Republic during the transition.

OBJECTIVES: To identify factors underlying the reduction in neonatal mortality in the Czech Republic during the 1990s and to identify scope for further improvements. DESIGN: Examination of trends in birth weight and birth weight specific neonatal mortality in the Czech Republic and comparison with figures from Sweden, which has one of the lowest neonatal mortality rates in Europe. SETTING: The Czech Republic. SUBJECTS: All singleton births occurring in the Czech Republic in 1989-1991 and 1994-1995, with a comparison group of all singleton births in Sweden in 1989-1991. MAIN OUTCOME MEASURES: Neonatal mortality rate. RESULTS: Despite a slight worsening in the birth weight distribution, the neonatal mortality rate in the Czech Republic fell from 5.6 to 3.8 per thousand live births. This was due to an improvement in the survival of infants at all birth weights but especially amongst the lightest. Eighty percent of the overall improvement was due to greater survival among those under 2500 g. Comparison with Swedish birth weight specific rates indicates that, for the country as a whole, only small additional gains are likely as a result of improved survival at a given birth weight but, instead, a reduction in the proportion of low birth weight babies would have a much greater effect. Regional analysis indicates that the improvements have been much greater in Prague than in the rest of the country. CONCLUSIONS: An effective strategy to reduce neonatal mortality in the Czech Republic should have two elements. The first is to address the socio-economic determinants of low birth weight. The second is to reduce regional inequalities in the quality of neonatal care. This should, however, be supplemented by more detailed investigation to identify specific amenable factors.

Birth Weight↗
PubMed1997

Efficient transduction of mammalian cells by a recombinant baculovirus having the vesicular stomatitis virus G glycoprotein.

Baculovirus vectors recently have been shown to be capable of efficient transduction of human hepatoma cells and primary hepatocytes in culture. This paper describes the generation of a novel recombinant baculovirus (VGZ3) in which the vesicular stomatitis virus glycoprotein G (VSV G) is present in the viral envelope. The gene encoding VSV G was inserted into the baculovirus genome under the control of the polyhedrin promoter such that it was expressed at very high levels in infected insect cells but not in mammalian cells. Expression of the lacZ reporter gene was driven by a promoter that is functional in mammalian cells (the Rous sarcoma virus long terminal repeat). We show by Western analysis that VSV G protein was present in purified baculovirus preparations. A VSV G monoclonal antibody blocked transduction of mammalian cells by VGZ3. This virus was morphologically distinct from baculovirus lacking VSV G, with virions adopting an oval rather than rod-shaped morphology. VGZ3 transduced human hepatoma cells in vitro at an efficiency roughly 10-fold greater than baculovirus lacking VSV G (the virus Z4). VGZ3 was also capable of transducing cell lines that could not be transduced efficiently by Z4. We provide evidence that VSV G protein may enhance transduction by increasing the efficiency of escape of baculovirus from intracellular vesicles rather than by increasing cell binding or uptake of the virus. The possible use of this and related baculoviruses in gene therapy is discussed.

Animals↗