Beyond borders: public-health surveillance.
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Animals↗
Biomedical subjects
Rifat Atun
Publications and source records attributed to Rifat Atun.
Public-private partnerships for hospitals.
While some forms of public-private partnerships are a feature of hospital construction and operation in all countries with mixed economies, there is increasing interest in a model in which a public authority contracts with a private company to design, build and operate an entire hospital. Drawing on the experience of countries such as Australia, Spain, and the United Kingdom, this paper reviews the experience with variants of this model. Although experience is still very limited and rigorous evaluations lacking, four issues have emerged: cost, quality, flexibility and complexity. New facilities have, in general, been more expensive than they would have been if procured using traditional methods. Compared with the traditional system, new facilities are more likely to be built on time and within budget, but this seems often to be at the expense of compromises on quality. The need to minimize the risk to the parties means that it is very difficult to "future-proof" facilities in a rapidly changing world. Finally, such projects are extremely, and in some cases prohibitively, complex. While it is premature to say whether the problems experienced relate to the underlying model or to their implementation, it does seem that a public-private partnership further complicates the already difficult task of building and operating a hospital.
Contract Services↗
Risk factors for pulmonary tuberculosis in Russia: case-control study.
OBJECTIVES: To determine risk factors for pulmonary tuberculosis in Russia. DESIGN: Case-control study of exposure to a variety of risk factors before and during the development of pulmonary tuberculosis. SETTING: Large city in Russia. PARTICIPANTS: Cases were 334 consecutive adults diagnosed as having culture confirmed pulmonary tuberculosis between 1 January 2003 and 31 December 2003. Controls were 334 individuals sampled from a validated population registry, matched for age and sex to the patients with tuberculosis. A questionnaire collected information on potential risk factors. MAIN OUTCOME MEASURES: Risk factors associated with the development of tuberculosis. RESULTS: The main risk factors for tuberculosis were low accumulated wealth (univariate odds ratio 16.70), financial insecurity (5.67), consumption of unpasteurised milk (3.58), diabetes (2.66), living with a relative with tuberculosis (2.94), being unemployed (6.10), living in overcrowded conditions (2.99), illicit drug use (8.74), and a history of incarceration in both pretrial detention centres (5.70) and prison (12.50). CONCLUSIONS: When prevalence of exposure is taken into account the most important factors in the development of pulmonary tuberculosis in Russia are exposure to raw milk and unemployment.
Adult↗
Antimicrobial prescribing patterns for respiratory diseases including tuberculosis in Russia: a possible role in drug resistance?
BACKGROUND: Inappropriate antibiotic prescribing exposes patients to the risk of side effects and encourages the development of drug resistance across antimicrobial groups used for respiratory infections including tuberculosis (TB). AIM: Determine among Russian general practitioners and specialists: (1) sources of antimicrobial prescribing information; (2) patterns of antimicrobial prescribing for common respiratory diseases and differences between primary and specialist physicians; (3) whether drug resistance in TB might be linked to over-prescribing of anti-TB drugs for respiratory conditions. METHODS: Point-prevalence cross-sectional survey involving all 28 primary care, general medicine and TB treatment institutions in Samara City, Russian Federation. In this two-stage study, a questionnaire was used to examine doctors' antimicrobial (including TB drugs) prescribing habits, sources of prescribing information, management of respiratory infections and a case scenario ('common cold'). This was followed by a case note review of actual prescribing for consecutive patients with respiratory diseases at three institutions. RESULTS: Initial questionnaires were completed by 81.3% (425/523) of physicians with 78.4% working in primary care. Most doctors used standard textbooks to guide their antimicrobial practice but 80% made extensive use of pharmaceutical company information. A minority of 1.7% would have inappropriately prescribed antibiotics for the case and 0.8-1.8% of respondents would have definitely prescribed TB drugs for non-TB conditions. Of the 495 respiratory cases, 25% of doctors prescribed an antibiotic for a simple upper respiratory tract infection and of 8 patients with a clinical diagnosis of TB, 4 received rifampicin monotherapy alone. Ciprofloxacin was widely but inappropriately used. CONCLUSION: Doctors rely on information provided by pharmaceutical companies; there was inappropriate antibiotic prescribing.
Anti-Bacterial Agents↗