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In the United States of America and in the republics of the former USSR, the elderly (persons aged 60 and over) will comprise the same proportion of their respective societies by the year 2000, namely 17%. In both countries, this population subgroup is growing at a faster rate than the rest of the population and living longer, although there are now more differences than similarities between the two countries in respect of the elderly, as summarized below. Similarities. In both countries today, the age group 50 years and over represents 26% of the total population, and by the year 2000 it is expected that 17% of the population will be 60 years and over. Diseases of the circulatory system and neoplasms are the major causes of death in both countries. Life expectancy beyond retirement age (i.e. the number of years a person is expected to live after having retired) is about the same in both, but this is due to the statistical fact that in the former USSR women are expected to have an extra year of life expectancy compared to their United States counterparts, while men are expected to live 2.5 years less beyond retirement than their United States counterparts. Differences. Mortality rates in the former USSR are higher than those in the United States. Life expectancy for men in the former USSR is 6.5 years below the figure for United States males. By age 65, the differences are 2.7 years for women and 2.4 years for men. Today, the proportion of the population having reached retirement age is larger in the former USSR than in the United States (17% vs 15%) because of lower retirement age in the former USSR. By the year 2000, these figures are expected to be 19% and 25%, respectively. Men make up 27% of the pension-age population in the former USSR against 41% in the United States. Life expectancy at birth could increase by 4 years for men in the former USSR if they had the same mortality rates from diseases of the circulatory and respiratory systems as their United States counterparts. Similarly, women in the former USSR would gain 4 years of life from these two causes alone. Older women are more likely to be married in the United States than in the former USSR, and this difference increases with age: at age 65, 25% of the former USSR's women are married versus 41% in the United States.
The aim of this paper is to assess trends in tuberculosis morbidity and mortality in the countries of Eastern Europe and the former USSR. Data on morbidity and mortality were obtained from reports of the Ministries of Health, a 1992 WHO questionnaire, national tuberculosis associations, and other sources. The quality of surveillance of tuberculosis cases differs widely between countries. Ranging from 19 to 80 per 100,000 population in 1990-1992, tuberculosis notification rates of most Eastern European and former USSR countries are higher than those of Western European countries. The lowest tuberculosis notification rate is reported in the Czech Republic, while the highest are reported in Romania and Kazakhstan. While in Albania, Croatia and Slovenia notification rates have continued to decline, in the remaining countries of Eastern Europe the declining trend has recently stopped. Nevertheless, countries such as the Czech Republic, Hungary, Poland and the Slovak Republic have experienced a distinct rate decrease when the 3-year average rate around 1985 is compared to that around 1990, despite the very recent levelling-off or increase. In Romania, the previous decline in notification rate ended in 1985 and in the period 1986-1992 an average 5.4% annual increase was observed. In this country, two-thirds of all cases still occur among young adults. Among the Baltic countries of the former USSR, the declining trend continues in Estonia, whereas in Latvia and Lithuania notification rates decreased less markedly from 1985 to 1990 than in the first half of the 1980s. Among the other European countries of the former USSR, Russia and Ukraine had a slow decline in the first half of the 1980s and a more pronounced one from 1985 to 1990. During the latter period of time, in Belarus and Moldova the decrease has been steeper. In the Caucasian countries of the former USSR, where underreporting and low case-finding are recognized, case rates have stabilized in Armenia, while in Azerbaijan and Georgia there was a decrease from 1985 to 1990. Among the Asian countries of the former USSR, Kazakhastan and Tajikistan reported a lower decline in case rates from 1985 to 1990 than from 1980 to 1985. Kyrgyzstan, Turkmenistan, and Uzbekistan reported increases in notification rates from 1985 to 1990: in Turkmenistan an average 5.5% annual increase in rate was observed between 1987 and 1991. Tuberculosis mortality is steadily increasing in Romania, Armenia, Kyrgyzstan, Latvia, Lithuania, Moldova, and Turkmenistan, while no decline is seen in most of the other countries of Eastern Europe and the former USSR.(ABSTRACT TRUNCATED AT 400 WORDS)
Serological responses to Epstein-Barr virus (EBV)-associated antigens were studied in nasopharyngeal carcinoma (NPC) patients in 2 countries non-endemic for the disease: the USSR (77 cases) and Cuba (55 cases). Two age- and sex-matched control groups were available, one consisting of patients with other head-and-neck tumours (OHNT) (171 from the USSR and 56 from Cuba), and the other of normal individuals (blood donors) (83 from the USSR and 80 from Cuba). Unlike the control groups, NPC patients from both countries had high levels of IgG and IgA antibodies, similar to those seen in patients from endemic areas. The only difference between NPC patients in the USSR and those in Cuba was lower (2-2.5 fold) anti-VCA IgG and IgA antibody titres. Using one-factor and multi-factor statistical methods the diagnostic value of different titres of EBV-specific IgG and IgA antibodies and their combinations for NPC patients (in the USSR) was evaluated. It was found that with simple mathematical analysis of EBV-specific antibody titres a differential diagnosis of NPC could be made to a significance level of 90%. The data obtained demonstrated the importance and reliability of EBV serology in the diagnosis of NPC in areas of low incidence of the disease.
The political-economic base of society affects every aspect of it, including nursing and psychiatry. This can be demonstrated by making a historical analysis of societies with different political-economic systems. Psychiatry in the USSR took a different form to psychiatry in the West. Differences included the diagnostic categories used and treatments employed. This can be investigated by examining accounts of clinical practice. Soviet psychiatry was also used for the systematic incarceration of political dissidents. Some commentators have drawn on the Soviet experience and used it to support an argument that psychiatry operates as a form of social control in the West as well as the USSR. This article shows how psychiatric abuse in the USSR was a historically specific response to a particular situation. Therefore some of the conclusions about Western psychiatry extrapolated from the Soviet experience are unsupportable. Whatever the role of psychiatry in the West, its mechanism is qualitatively different to that which existed in the USSR. In order to understand why Soviet medical workers were co-opted into the conscious abuse of psychiatry, it is essential to understand the specific nature of the USSR. This does not necessarily allow generalizations about Western psychiatry to be made from the Soviet experience. As psychiatric nurses, we can also learn from a particularly tragic period of psychiatry's history.
Metrological service in the USSR was the first of its kind in the world. The Central Research Roentgenoradiology Institute is a base of the USSR Ministry of Health in the field of ionizing radiation measurements; it was set up on its initiative in 1961. Seven years later WHO experts in Geneva raised a question of the organization of a similar world service. At present the USSR metrological service comprises 2 bases (at the Central Research Roentgenoradiology Institute and at the Moscow Research Roentgenoradiology Institute) and 11 territorial testing dosimetric laboratories in the majority of the USSR regions. They are responsible for testing gamma-therapeutic apparatus. Owing to this service the quality of radiation therapy in the USSR was improved.
An epidemic wave of influenza caused by the A2 virus was recorded in the USSR in the winter of 1966-67; this was the fifth wave since this pandemic strain first appeared. In contrast to the last wave of 1965, it developed simultaneously with, or followed, an epidemic of influenza B. The epidemic spread of influenza was observed for a period of 2 years in the USSR; influenza B prevailed in 1966, influenza A2 in 1967, and the two viruses spread at different speeds. A slow spread and a gradual increase in intensity during most of the year was characteristic of influenza B while influenza A2 spread rapidly and involved a considerable part of the country within 3 months.Although the influenza B started to spread almost 9 months before influenza A2 became active, the periods of maximum intensity of both outbreaks coincided in most parts of the USSR in the winter of 1966-67. The approach of summer temporarily stopped the spread of influenza B but did not bring the outbreak to an end nor lessen the intensity of the next wave in the autumn. Among the haemagglutinating agents isolated in the USSR in 1966-67 were 121 strains of virus B and 132 strains of virus A2. A study of the antigenic structure of the B strains showed that they were not all similar; some of them were closely related to B/Johannesburg/33/58, a greater number were more closely related to B/Singapore/3/64 and a number of strains differed from both varieties.Among the A2 viruses isolated and investigated were strains similar to those of pandemic prototype A2/Singapore/1/57, strains close to A2/England/12/64 and A2/USSR, Gor/62/65, strains antigenically different from all those strains but still related to the A2 subtype and strains that had S-antigen of A-type but which were not inhibited by antisera to the prototypes A2/57, A2/64 or A2/67.Outbreaks of influenza A2 and B recorded in the USSR are considered to be parts of the global influenza epidemics.
At the same time as substantial and rapid socio-political and socio-economic changes took place during the period of perestroika, suicide rates in the former USSR decreased by approximately 32% for men and 19% for women. The decreases in the suicide rates of men in the former USSR were unlike the suicide rate decreases taking place in 22 other European countries, where rates decreased by approximately 8% for men and 17% for women during this time period. Declines in suicide rates from 1984 to 1986-1988 occurred in all republics, with the largest decreases in Russia and Belarus, at 42% for men and 20% for women. The decrease in suicide rates of men in the former USSR was most pronounced until 1986-1988, after which time an increasing trend was observed. Suicide rates for men in the former USSR decreased 3.8-fold more than they did for men in other parts of Europe, while decreases in the suicide rates for women in the former USSR were on the same level as in Europe.
A survey of the current management of Graves' disease was performed in the USSR among members of All Union Endocrine Society. The questionnaire was based on the format used previously for a survey of members of European Thyroid Association. The aim of a similar survey in the USSR was to obtain a comprehensive pattern of management of Graves' disease in Soviet endocrinology clinics and to compare medical attitudes in the former USSR to those in other European countries. One hundred and twenty questionnaires were mailed with 55 returned (46%). The responses originated from 33 cities, representing major endocrinology centers of the former Soviet Republics. Initial diagnosis was conducted both in hospitals (55%) and ambulatory care settings (45%). Thyroid scintigraphy was requested by 42.3% of the respondents; a majority of them (90%) used 131I. Thyroid ultrasonography was performed in more than 50% of cases. Measurements of cholesterol, total T4 and T3 were the most frequent laboratory tests requested to confirm the diagnosis. For the treatment with ATD, methimazole was the exclusive choice (PTU is not currently in use in the USSR). Beta-blocking agents were prescribed by a majority of respondents. For the long term treatment, a combination procedure of MMI and thyroid hormones was clearly preferred by almost 3/4 of the respondents. A fixed period of treatment was preferred by 62% of the respondents, with a duration of therapy of 18-24 months. Surgery for treatment of the index patient was chosen by only 6%, and radioiodine by 3%. The number of responses was too limited to attempt any characterization of the two latter modalities.
The etiological role of S. boydii in Shigella infections registered at different territories of the USSR in 1986-1987 was analyzed. As established by this analysis, S. boydii infection occurred mainly at the territories with unsatisfactory water supply of the population; from these territories the infection spread to ther territories of the USSR. The dominating serovars causing S. boydii dysentery, as well as Shigella infections, at different territories of the USSR was shown to be identical, which was indicative of the fact that the immunological factor had no influence on the etiological structure of Shigella infections, determined by the activity of the main routes of the transfer of infection. On the whole, S. boydii serovars 2, 4 and 1 were found to prevail in the USSR.
For years, the Health Service of the USSR was considered a model and a guide. Countries in the Third World were invited to follow its various elements in organizing their own national health systems. But, since August 1987, everybody has known that the Health Service of the USSR is in a very bad situation. Official reports, journals of the Party and declarations of the health authorities all emphasized the catastrophic state of the health care organization in USSR: rising mortality rates, alcohol and drug abuse, extensive pollution, hospitals without hygiene or equipment, lack of professionalism and extended corruption among medical doctors and other health workers, patients' dissatisfaction etc... Of special concern are the cardiovascular and maternal mortality rates which are now much higher than in other countries. In the wake of perestroïka, a plan of reform was initiated by the Party and the Government, and was announced in 1988 by Health Minister E.N. Tchazov. The basic principle of the Health Service in the USSR remains prevention. Nevertheless, a great number of new measures will be implemented. Health information and care will be brought to the people by health workers. Mass screening for the most frequent diseases will be performed. Computers will be used on a large scale for managing high risk groups. Health centers will be strengthened. But the most revolutionary element of the reform will be the extension of the "paying sector", with increased number of facilities having financial autonomy. These facilities provide care and require some payment from the patients. They existed previously, but in the future they will be increased and strengthened. This means that the patients will have to pay more money but the services will be likely improved. The future will show whether the plan will succeed or fail.
Analysis of comparative surveillance on influenza carried out in the USSR and the GDR is presented. It was shown that both in the nonepidemic and epidemic seasons the incidence of influenza in the USSR increased considerably earlier than in the GDR. In the nonepidemic season of 1978-1979, strains of different antigenic structure were in circulation in the USSR and the GDR, whereas the epidemic of 1979-1980 was induced by new drift variants of A(H3N2) virus, A/Bangkok/1/79 and A/Bangkok/2/79. The epidemic strains circulating in both countries were dissimilar biologically and antigenically. In the nonepidemic period in the USSR and GDR the circulating A(H1N1) strains were represented not only by drift variants A/USSR/90/77 and A/Brazil/11/78 but also by natural recombinants of A(H1N1), A/USSR/61/79, in which the internal proteins (P, NP, NS, and M) were analogous to those of A(H3N2).
"This article investigates economic region net migration patterns in the USSR during the 1979-89 intercensal period. Net in-migration and net migration rate increases (compared to 1970-79) occurred in both the western and eastern portions of the Northern USSR region, while net out-migration and rate declines occurred throughout the Southern USSR. Net in-migration again occurred to Siberia, especially Tyumen' Oblast, and there was a reduced rate of net out-migration from the Nonchernozem Zone and Central Chernozem Region of European RSFSR."
This article provides an overview of health data available in the former USSR. It is not all-inclusive in terms of chronic diseases covered or in details of data collection activities carried out. However, several broad conclusions can be drawn: There is a system of population and mortality data collection which covers the former USSR and which can be disaggregated to smaller administrative areas. The system is being exploited by population specialists, demographers, medical demographers and epidemiologists, both nationally and internationally, both for analytical purposes and as part of health monitoring systems. A national-level data-collection system for morbidity and disability, based on delivery of health services, is in place and is exploited by both health researchers and health planners. The shortcomings of such a health service-based statistical system are well recognized. Further standardization or calibration of measures of total and cause-specific morbidity and disability measures should be examined. A potential calibration tool is the 1988-1993 health examination and interview survey covering a representative (but highly clustered) sample of the former USSR population. The possibilities of greater standardization of measurement procedures used in this survey should also be investigated. In certain disease areas, e.g. cardiovascular diseases, cancer, rheumatic diseases and gerontology, clinical and epidemiological studies involving international collaboration have been carried out. This has resulted in the use of internationally accepted disease definitions, diagnostic procedures, and of clinical and laboratory standardization of demographic, social and biological measurements. Participation in multilateral or bilateral studies should be encouraged in research in disease areas where these types of programmes have not yet been instituted.(ABSTRACT TRUNCATED AT 250 WORDS)
In 1988, the USSR Ministry of Public Health published official statistics on abortion for the first time in 60 years. Using the official data published in 1988 and unofficial statistics from a variety of independent sources, this report attempts to describe some of the basic features of fertility regulation in the USSR. Induced abortion is the main method of fertility regulation throughout the country, and a high proportion of induced abortions are unregistered and performed illegally. The availability and use of modern contraceptives is low; among those who practice contraception, traditional methods predominate. The official data leave much to be desired in the way of accuracy, reliability, and completeness. However, it is clear that the level of induced abortion is higher in the USSR than in any other country in the world.
Trends in age-specific and age-standardized mortality from 10 major cancer sites and total cancer mortality in the USSR were analyzed for the period 1965-1990, on the basis of the World Health Organization mortality database. Gastric cancer mortality declined substantially. Still, these rates were among the highest registered in the world, and in 1990 stomach cancer accounted for over 85,000 deaths, being the second cause of cancer death (and the first one until 1980); further, there was some indication of a levelling of the declines in gastric-cancer rates for both sexes over most recent calendar years. Likewise, uterine-cancer mortality declined between 1965 and 1985, but there was no further decline over the last 5 years. Upward trends were registered for cancers of the intestine, of the breast and of the prostate. Mortality from these neoplasms, however, was still comparatively low by worldwide standards. Leukaemia rates were stable in both sexes. Substantial rises were observed for cancers of the oral cavity and pharynx, larynx and, chiefly, lung. Even more unfavourable was lung-cancer mortality in young and middle-aged males, since the truncated rate of 121/100,000 in 1990 was higher than the values reached by countries like England and Wales or Finland even at the top of their epidemic in the 1960s, and trends in the USSR were still upwards. Thus, total cancer mortality was 176/100,000 males in 1965, declined to 170 in 1970, but increased thereafter, particularly over the last decade, to reach 203/100,000, i.e., one of the highest rates on a worldwide scale. Among females, the overall cancer mortality rate declined between 1965 and 1975, but rose thereafter to a value intermediate on a worldwide scale. These recent unfavourable trends of cancer mortality in the USSR indicate that, in the absence of adequate intervention, particularly on the tobacco-related cancer epidemic, overall cancer mortality will continue to rise in the foreseeable future.
This review discusses the toxicological and hygienic aspects of the extensive increase in pesticide use, which has resulted in the great majority of people throughout the world being affected by their presence. The need for a broad exchange at an international level of the findings of toxicological and hygienic research is established. Brief information on the development of pesticide toxicological research in the USSR is also presented. Accepted criteria for toxicological and hygienic pesticide assessments in the USSR are also systematically reviewed, with respect to the evaluation of physical and chemical properties, toxicity as defined through acute and subacute experiments, cumulative properties, and effects on skin and mucous membranes. The methodology for establishing threshold and noneffective (harmless) levels is also described, along with the prediction of delayed adverse effects. Other areas discussed include the classification of pesticides by degree of toxicity and danger, the system of research and regulation in the USSR, and the principle of integrated standardization of pesticide content of food, water, and atmospheric air. The review concludes with a look at certain prospective trends in the search for and development of pesticides that have selective action on target organisms but are harmless to human health and the environment.