Health and health care in transitional Europe

Psychological Distress and Problem Drinking

We examine the influence of harmful alcohol use on mental health using a flexible two-step instrumental variables approach and household survey data from nine countries of the former Soviet Union. Using alcohol advertisements to instrument for alcohol, we show that problem drinking has a large detrimental effect on psychological distress, with problem drinkers exhibiting a 42% increase in the number of mental health problems reported and a 15% higher chance of reporting very poor mental health. Ignoring endogeneity leads to an underestimation of the damaging effect of excessive drinking. Findings suggest that more effective alcohol policies and treatment services in the former Soviet Union may have added benefits in terms of reducing poor mental health.

Perception of health risks among adolescents due to consumption of cigarettes, alcohol and psychoactive substances in the Federation of Bosnia and Herzegovina

OBJECTIVES

This article describes the perception of health risks in adolescents due to the consumption of cigarettes, alcohol and psychoactive substances in the Federation of Bosnia and Herzegovina (FBIH), as well as their observation of the behavior of their peers related to addictive behaviors.

METHODS

For the analysis was used a database from the European School Survey Project on Alcohol and Other Drugs (ESPAD) survey which was conducted in FBIH in 2011. The target population were students in the second grade of secondary schools in FBIH born in 1995 according to the ESPAD protocol. The total number of respondents from the cohort born in 1995 was 3813 students.

RESULTS

The research results showed that the prevalence of risk perception due to the consumption of cigarettes, alcohol and psychoactive substances among adolescents in the FBIH is lower than the mean prevalence in countries which have implemented the ESPAD survey of 2011.

CONCLUSIONS

PPreventive activities should be aimed at adolescent risk behaviours and empower them to make the right decisions that can have far reaching significance. Attention has to be paid to selective prevention that is directed towards individuals or subgroup of population where the risk of developing disorder is much higher than average.

Age-related changes in general and sexual health in middle-aged and older men: results from the European Male Ageing Study (EMAS)

INTRODUCTION

Limited information is available concerning the general and sexual health status of European men.

AIM

To investigate the age-related changes in general and sexual health in middle-aged and older men from different countries of the European Union.

METHODS

This is a cross-sectional multicenter survey performed on a sample of 3,369 community-dwelling men aged 40-79 years old (mean 60 + or - 11 years). Subjects were randomly selected from eight European centers including centers from nontransitional (Florence [Italy], Leuven [Belgium], Malmö[Sweden], Manchester [United Kingdom], Santiago de Compostela [Spain]) and transitional countries (Lodz [Poland], Szeged [Hungary], Tartu [Estonia]).

MAIN OUTCOME MEASURES

Different parameters were evaluated including the Beck's Depression Inventory for the quantification of depressive symptoms, the Short Form-36 Health Survey for the assessment of the quality of life (QoL), the International Prostate Symptom Score for the evaluation of lower urinary tract symptoms, and the European Male Ageing Study sexual function questionnaire for the study of sexual function.

RESULTS

More than 50% of subjects reported the presence of one or more common morbidities. Overall, hypertension (29%), obesity (24%), and heart diseases (16%) were the most prevalent conditions. Around 30% of men reported erectile dysfunction (ED) and 6% reported severe orgasmic impairment, both of which were closely associated with age and concomitant morbidities. Only 38% of men reporting ED were concerned about it. Furthermore, concern about ED increased with age, peaking in the 50-59 years age band, but decreased thereafter. Men in transitional countries reported a higher prevalence of morbidities and impairment of sexual function as well as a lower QoL.

CONCLUSION

Sexual health declined while concomitant morbidities increased in European men as a function of age. The burden of general and sexual health is higher in transitional countries, emphasizing the need to develop more effective strategies to promote healthy aging for men in these countries.

The quality of care in post-soviet Uzbekistan: are health reforms and international efforts succeeding?

The idea of healthcare quality improvement (QI) and disseminating evidence-based practice has been attractive for local health policy makers in Uzbekistan since the early 2000s. One aspect in need of discussion is the degree to which the country's healthcare system is open for the proposed QI activities. Funding of health care resulted in building and equipping rural primary care practices, training medical and administrative personnel for these practices, and vesting some regulatory functions at primary care level and enhancing their autonomy from the central regional hospitals. However, these inputs did not provide the sustainability of practices required to meet the needs for improvement in local quality of care. Although standards are effective tools for external and internal quality control, their development in Uzbekistan is rather sporadic and has not been regulated. An important quality of care issue is the need for evidence-based medicine fundamentals to be taught in graduate and postgraduate curricula. However, efforts to implement this through the training of medical school teachers and students have weak support from faculty heads, despite being declared to be among the institute's priorities. International policy regarding Uzbekistan currently ranges from local short-term health projects to large-scale medium-term efforts. The latter are very ambitious, but are the most resource- and time-consuming. In contrast to the view that developing world health systems are becoming more flexible to local QI projects, the post-Soviet health systems, including that in Uzbekistan, seem to resist such interventions.

Patient involvement in assessing consultation quality: a quantitative study of the Patient Enablement Instrument in Poland

BACKGROUND

Promoting a more patient-responsive service has been the focus of policy initiatives in newer EU states. One measure of success should be the patient's assessment of their consultation with their doctor.

OBJECTIVES

To measure consultation quality in Polish primary care using patient enablement (a patient-driven instrument developed in the UK) and to test its theoretical framework. To compare the patient enablement outcome of different types of doctor delivering primary care in Poland following reform.

DESIGN

Cross-sectional quantitative questionnaire survey.

SETTING

Random sample of primary care doctors practising within a 60-km radius of Gdansk, Poland.

SUBJECTS AND OUTCOME MEASURES

Patient Enablement Instrument and correlates were measured in 7924 consecutive adult consultations of 48 doctors, stratified according to training: family medicine specialists (diploma holders), non-diplomates and general medicine doctors (polyclinic internists).

RESULTS

Completion was high (78%). The mean patient enablement score in Poland was 4.0 (SD 3.3) and mean consultation length was 10.3 min (SD 5.4 min). Consultation length and knowing the doctor are independently related to patient enablement in the Polish context. Variation between doctors is significant, but earlier differences in enablement between alternative providers have largely been ameliorated in practice.

CONCLUSION

It is feasible to use patient enablement on a large scale at routine consultation in primary care in Poland: acceptability was good in diverse environments. The internal consistency of enablement and its relationships broadly mirror those found in the UK. The effect of patient expectations shaped by social and cultural issues influencing enablement outcome requires further investigation.

Demographics and motives of medical school applicants in Croatia

BACKGROUND

According to data regarding number of physicians per 100,000 inhabitants, Croatia is below the European average. Under those circumstances, more attention needs to be devoted to Croatian medical schools and their applicants.

AIMS

This study sought to investigate admission trends of applicants to Croatian medical schools, analyse their demographics and motives for medical school enrollment.

METHODS

We collected admissions data of applicants to Croatian medical schools from 1979 to 2006. Motives for and against medical school enrollment were assessed in a survey of 1146 applicants (response rate 84%, 966/1146) and 98 final-year medical students (response rate 82%, 80/98) during July 2006.

RESULTS

The number of applicants to Croatian medical schools had been declining until 1995, it was lowest during the 1991-1995 war in Croatia and it has been rising from 1996 onwards. Majority of applicants in 2006/07 were women (69%). Most of the applicants attended general high schools. The applicants profess choosing a certain medical school for its quality and reputation, but we showed that they actually chose the closest school. The main motives for medical school enrollment were humanitarian and scientific, while main reasons against were perceived difficulty and financial burden. We showed that final-year medical students profess significantly lower interest in science and that they are less interested in altruistic aspects of medicine. Instead, great number of them would reconsider choosing medical studies again because of the corruption in medicine, fear of mistakes and uncertainty of employment.

CONCLUSIONS

Following the admission trends in medical schools on a national level gives insight into the prospects of health care. Analysis of motives for and against medical school enrollment can provide guidelines for their improvement. Unless Croatia and other countries in transition devote more attention to recruitment, education and retention of physicians, the prospects of our healthcare are poor.

Primary care in a post-communist country 10 years later Comparison of service profiles of Lithuanian primary care physicians in 1994 and GPs in 2004

OBJECTIVES

The study aimed, firstly, to assess changes in the service profile of primary care physicians between 1994, when features of the Soviet health system prevailed, and 2004, when retraining of GPs was completed. Secondly, to compare service profiles among current GPs, taking into account their positions before being retrained.

METHODS

A cross-sectional repeated measures study was conducted among district therapists and district pediatricians in 1994 and GPs in 2004. A questionnaire was used containing identical items on the physicians' involvement in curative and preventive services. The response rates in both years were 87% and 73%, respectively.

RESULTS

In 2004, physicians had much more office contacts with patients than in 1994. Modest progress was made with the provision of technical procedures. Involvement in disease management was also stronger in 2004 than in 1994, particularly among former pediatricians. Involvement in screening activities remained stable among former therapists and increased among former pediatricians. At present, GPs who used to be therapists provide a broader range of services than ex pediatricians. GPs from the residency programme hold an intermediate position.

CONCLUSIONS

Lithuanian GPs have taken up new tasks but variation can be reduced. The health care system is still in the midst of transition.

Importance of health care issues in 2005 presidential elections in Croatia

Health and health care provision are among the most important and politically sensitive public service areas. Politicians carefully incorporate health care program changes in their political agendas to gain votes. However, knowing health care priorities of the electoral body is not useful only to politicians, but also to health policy makers, as it enables them to target the most problematic areas in health care. We conducted a telephone survey of representative sample of voters (n=643) immediately before the presidential elections in Croatia in 2005, to determine the possible differences in health care priorities between left-wing and right-wing voters, and found a high level of homogeneity in their opinions. Health care organization, corruption, and financing issues were identified as the top priorities by both left- and right-wing voters. This agreement in voters' expectations, probably caused by a similar frame of mind of Croatian citizens inherited from pre-democratic times of self-government, could be used by health policy makers to rationally invest the means and efforts in dealing with the most problematic health care issues.

Premature mortality in Slovenia in relation to selected biological, socioeconomic, and geographical determinants

AIM

To determine biological (sex and age), socioeconomic (marital status, education, and mother tongue) and geographical (region) factors connected with causes of death and lifespan (age at death, years-of-potential-life-lost, and mortality rate) in Slovenia in the 1990s.

METHODS

In this population-based cross-sectional study, we analyzed all deaths in the 25-64 age group (N=14 816) in Slovenia in 1992, 1995, and 1998. Causes of death, classified into groups according to the 10th revision of International Classification of Diseases, were linked to the data on the deceased from the 1991 Census. Stratified contingency-table analyses were performed. Years-of-potential-life-lost (YPLL) were calculated on the basis of population life-tables stratified by region and linearly modeled by the characteristics of the deceased. Poisson regression was applied to test the differences in mortality rate.

RESULTS

Across all socioeconomic strata, men died at younger age than women (index of excess mortality in men exceeded 200 for all studied years) and from different prevailing causes (injuries in men aged <45 years; neoplasms in women aged >35 years). For men, higher education was associated with fewer deaths from digestive and respiratory system diseases. The least educated women died relatively often from circulatory diseases, but rarely from neoplasms. Single people died from neoplasms less often. Marriage in comparison with divorce reduced the mortality rate by 1.9-fold in both men and women (P<0.001). Mortality rate in both men and women decreased with increasing education level (P<0.001). Mortality rate of ethnic Slovenians was half the mortality rate of ethnic minority members and immigrants (P<0.001). Analysis of YPLL revealed limited and nonlinear impact of education level on premature mortality. The share of neoplasms was the highest in the cluster of socioeconomically prosperous regions, whereas the share of circulatory diseases was increased in poorer regions. Significant differences were found between individual regions in age at death and mortality rate, and the differences decreased over the studied period.

CONCLUSION

These data may aid in understanding the nature, prevalence and consequences of mortality as related to socioeconomic inequalities, and thus serve as a basis for setting health and social policy goals and planning health measures.