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Countries of Eastern Europe and the Commonwealth of Independent States are facing a combination of difficulties in health including high rates of mortality from preventable diseases, and pressures for reform of their health care systems. The development of schools of public health is an important priority for international aid and for national government attention. This provides a challenge of integrating experience from many countries in the industrialized world and academic centers of excellence in the field of public health. Traditional departments of social hygiene within medical academies need to evolve to educate new generations of doctors to cope with challenges facing the health systems in these countries. Development of post-graduate centers of training will also be needed as independent schools of public health within single or multi-faculty universities to train health workers in a New Public Health. This paper outlines the mission of a school of public health (SPH), and the steps needed to achieve its objectives, with examples of several schools at relatively advanced and moderate levels of development. The purpose is to provide guidelines for those SPHs under development that are seeking international support and resources.
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A standardized curriculum in emergency and disaster medical response for use in the former Soviet Union was implemented under an American International Health Alliance partnership program involving over 60 healthcare and educational institutions in the United States and the Commonwealth of Independent States. The core curriculum was based on U.S. standards and developed in collaboration with local faculty to address emergency and disaster medical needs specific to the region. Local faculty members were trained by U.S. partners using a train-the-trainers methodology at U.S. partner institutions. This partnership program led to the development of 16 regional training centers in 11 countries over an 8-year period. Over 39,000 healthcare workers and first responders have now been trained throughout this network of regional training centers. Wide dissemination of standardized training encourages uniform delivery of medical care within regions and may facilitate provision of mutual aid between regional jurisdictions.
This symposium describes the advances in immunology that have occurred in the Commonwealth of Independent States. The worldwide difficulties of allergists and immunologists who face problems including increasing morbidity and mortality from HIV, immunoregulatory disorders, and asthma are also germane to our colleagues in Russia, Belarus, and Ukraine. The unique experiences of Dr. Petrov, who has investigated novel immunomodulators; Dr. Titov, who has studied synthetic immunogens; Dr. Babakhin, who has investigated the effects of modified allergens; and Dr. Sidorovitch, who has explored the pathogenesis and natural history of HIV infections occurring in Russia, offer interesting insights into the advances in immunology that have occurred in the Commonwealth of Independent States. Coping with the tragedies of radiation from Chernobyl and environmental pollution in Ukraine, Drs. Titov and Markov have investigated the effects of these unfortunate disruptions of the environment upon the occurrence of immunoregulatory disorders and asthma, respectively. Under the direction of Drs. Petrov and Khaitov, immunologist from the Commonwealth of Independent States, have conducted studies that are among the leading epidemiological immune investigations of our time to determine the effects of the Chernobyl radiation on the immune system.
Precise information on the number of workers currently exposed to carcinogens in the Commonwealth of Independent States (CIS) is lacking. However, the large number of workers employed in high-risk industries such as the chemical and metal industries suggests that the number of workers potentially exposed to carcinogens may be large. In the CIS, women account for almost 50% of the industrial work force. Although no precise data are available on the number of cancers caused by occupational exposures, indirect evidence suggests that the magnitude of the problem is comparable to that observed in Western Europe, representing some 20,000 cases per year. The large number of women employed in the past and at present in industries that create potential exposure to carcinogens is a special characteristic of the CIS. In recent years an increasing amount of high-quality research has been conducted on occupational cancer in the CIS; there is, however, room for further improvement. International training programs should be established, and funds from international research and development programs should be devoted to this area. In recent years, following privatization of many large-scale industries, access to employment and exposure data is becoming increasingly difficult.
The data on the spread of AIDS among homosexuals (HS) are presented. Studies carried out in the CIS and Baltic countries in 1995-1997 revealed that this group formed a highly favorable environment for the spread of HIV infection and sexually transmitted diseases (STD). The discrepancy between the real number of HIV carriers and the number of detected cases is explained by the specific character of their existence in the society. The potential possibility of the rapid spread of HIV infection among HS required the preparation of a number of minor pilot projects on the prophylaxis of HIV among this group in the capitals of the CIS countries.
This paper examines the measurement of infant mortality in the countries of Central and Eastern Europe and the Commonwealth of Independent States (CIS). There are worrying indications that official infant mortality counts, based on administrative data, may understate the true gravity of the problem in 15 countries in the region, including 11 out of 12 CIS countries, and 4 countries in South Eastern Europe. In the case of eight CIS countries in the Caucasus and Central Asia plus Romania, the evidence is strongest, not least because surveys that allow independent estimation of infant mortality have been carried out there. In the case of the remaining six countries, the evidence is more circumstantial, and based on inconsistencies within the official data themselves, combined with information on how live births are defined. However, we find also that surveys are rather blunt instruments, and that the confidence intervals that surround estimates from these surveys are often large.
PURPOSE: This study assessed the performance of dental hygiene services and the perception of preventive oral health care in the Commonwealth of Independent States (CIS), formerly known as the USSR. METHODS: In April 1996, questionnaires were distributed to a convenience sample of 200 dentists in four cities of the CIS: Moscow, St. Petersburg, Kiev, and Odessa. All questions were designed for practicing dentists since the dental hygiene profession in the CIS is not presently recognized. RESULTS: The overall response rate was 93% (N = 186). The results indicated that oral hygiene care is provided by dentists on a selective, non-routine basis. The number of missing teeth in persons age 35 is 5 to 7. An oral prophylaxis in the CIS accounts for 3.1 percent of all dental visits and is performed to either remove deposits that create an obstacle to oral health care treatment or, less often, to improve the esthetic appearance of teeth. Approximately 75 percent of the dentists responding indicated they perform periodontal probing on patients with obvious periodontal problems. Fluoride supplements are provided by 82 percent of respondents, although three-fourths do not perform routine bitewing radiographs and occlusal sealants. The majority indicated a need for dental hygienists to be employed within the CIS oral health care system. CONCLUSION: The study indicates a critical need for developing dental hygiene in the CIS. It is recommended that preventive oral health care be provided by dental hygienists who have been formally educated in such a curriculum.
AIMS: To describe the frequency of alcohol consumption and beverage preferences in eight countries of the Commonwealth of Independent States (CIS). DESIGN: Cross-sectional. SETTING: Populations of Armenia, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Republic of Moldova, Russian Federation and Ukraine. PARTICIPANTS: Representative samples of the adult population of each country (overall sample size 18,428; response rates: 71-88%). MEASUREMENTS: A standardised questionnaire was administered by trained interviewers to examine alcohol consumption frequency and usual intakes of beer, wine and strong spirits. FINDINGS: Between 11 and 34% of males and 26-71% of females reported never drinking alcohol. Abstention was lowest in the Russian Federation and Belarus, two traditional spirits-drinking countries. It was particularly high in Kyrgyzstan and Georgia, two countries with a relatively low frequency of alcohol consumption but large amounts consumed per occasion (particularly Georgia). On the contrary, Moldovan respondents drank frequently, but consumed smaller amounts per occasion. As expected, spirits were consumed in largest amounts in traditional spirits-drinking countries, as well as Armenia and wine in traditional wine-drinking countries. Beer consumption was relatively high in Russia, Belarus, Ukraine and Kazakhstan (males), particularly in young respondents. CONCLUSIONS: Although cross-country comparisons of alcohol intake should be interpreted cautiously, this study suggested that drinking patterns in the countries examined are not entirely typical of usual dry/wet drinking cultures, and confirms that the CIS is very diverse in terms of drinking patterns and beverage preferences. The study provides an important baseline for future comparisons as markets open to new products, as has been the case elsewhere in Europe.
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This study examined the differential effect of age on coping and psychological measures among immigrants from Commonwealth of Independent States (CIS) to Israel. Some of these immigrants originated in the Republics adjacent to the Chernobyl Power Plant, site of the 1986 accident. The sample consisted of 708 immigrants who were interviewed between the years 1993-1995 with an average age of 47.5 (sd 11.8). This sample was reinterviewed approximately a year and three months later (n = 520). The sample included two exposure groups--high exposed and low exposed based on the estimated levels of ground cesium contamination from the IAEA maps and a comparison group matched by age, gender, and year of immigration. Those over the age of sixty-five were disadvantaged, compared to those aged fifty to sixty-four, and younger, when it came to the tasks of immigrant absorption; learning the language, working and acquiring an income, and establishing alternative social networks which could offer support in times of illness. The psychological variables showed that over time, somatization, depression, and post-traumatic stress disorder (PTSD) symptoms related to Chernobyl improved, however at a much slower pace for older immigrants (aged 55 and over) compared to younger ones.
This review aims to summarize the basic research in the field of intermittent hypoxia in the Soviet Union and the Commonwealth of Independent States (CIS) that scientists in other Western countries may not be familiar with, since Soviet scientists were essentially cut off from the global scientific community for about 60 years. In the 1930s the concept of repeated hypoxic training was developed and the following induction methods were utilized: repeated stays at high-mountain camps for several weeks, regular high altitude flights by plane, training in altitude chambers, and training by inhalation of low-oxygen-gas mixtures. To the present day, intermittent hypoxic training (IHT) has been used extensively for altitude preacclimatization; for the treatment of a variety of clinical disorders, including chronic lung diseases, bronchial asthma, hypertension, diabetes mellitus, Parkinson's disease, emotional disorders, and radiation toxicity, in prophylaxis of certain occupational diseases; and in sports. The basic mechanisms underlying the beneficial effects of IHT are mainly in three areas: regulation of respiration, free-radical production, and mitochondrial respiration. It was found that IHT induces increased ventilatory sensitivity to hypoxia, as well as other hypoxia-related physiological changes, such as increased hematopoiesis, alveolar ventilation and lung diffusion capacity, and alterations in the autonomic nervous system. Due to IHT, antioxidant defense mechanisms are stimulated, cellular membranes become more stable, Ca(2+) elimination from the cytoplasm is increased, and O(2) transport in tissues is improved. IHT induces changes within mitochondria, involving NAD-dependent metabolism, that increase the efficiency of oxygen utilization in ATP production. These effects are mediated partly by NO-dependent reactions. The marked individual variability both in animals and humans in the response to, and tolerance of, hypoxia is described. Studies from the Soviet Union and the CIS significantly contributed to the understanding of intermittent hypoxia and its possible beneficial effects and should stimulate further research in this direction in other countries.
Serologic V3 loop peptide-binding assays have been used to predict divergent human immunodeficiency virus type 1 (HIV-1) strains from the Commonwealth of Independent States (former Soviet Union) that have been subsequently confirmed by sequencing of the V3 region. Initial screening was done by MN V3 peptide binding; 12 parenterally infected HIV-1-positive subjects from Elista and Rostov (group 1) with low-titer MN binding and 6 heterosexually infected HIV-1-positive adults from Byelorussia (group 2) with high-titer MN binding were selected. A consensus sequence from the Elista and Rostov areas was generated; a corresponding 14-mer peptide was synthesized and used in an indirect ELISA to screen sera from 392 individuals from diverse geographic areas. Reactivity to the consensus peptide was 82% in subjects from the homologous areas and 11%-38% in other areas. Antibody binding to a panel of synthetic V3 peptides may be used to predict the presence of diverse strains of HIV-1 within virally heterogenous populations.
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We compared echovirus 30 strains (FDJS03) which caused an outbreak of aseptic meningitis in China in 2003 with other human enterovirus B strains. Sequencing of the complete genome of FDJS03_84, a representative strain from this outbreak, revealed a mosaic structure with a putative recombination spot within the 2B gene. It was most similar to a strain of the same serotype, E30-14125-00, in the 5' half of the genome but was almost equidistant to all strains analyzed in most of the 3' half of the genome. Phylogenetic relationships in the 5'-untranslated region and the VP1 gene indicated that the FDJS03 isolates were closely related to a distinct lineage of E30 which circulated in countries of the Commonwealth of Independent States during 1999 and 2000. It is most likely that the ancestor of FDJS03 isolates experienced multiple recombination events in the nonstructural protein coding region, which were partly observed in the phylogenetic analysis of the 3D region.
Spores of microsporidia have been recovered in 5 specimens of 13 ixodid ticks Ixodes ricinus from various populations of the Republic Moldova collected in spring of 2004. Microsporidia were detected by means of fluorescent microscopy. Intensity of infection was 3-6 spores per a micropreparate from one mite. Based on spore size, character of staining and the presence of diplocarion, these spores are referred to the Nosema-like type. Low intensity of infection probably is caused by that fact that ticks were collected in spring period and were unfed.