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Ianache I, Skrzat-Klapaczynska A, Jilich D, Fleischhans L, Gmizic I, Ranin J, Papadopoulos A, Protopapas K, Mulabdic V, Lakatos B, Nagy EL, Begovac J, Holban T, Sevgi DY, Cicic A, Yancheva N, Sojak L, Rukhadze N, Kowalska J, Oprea C. Mpox across countries from Central and Eastern Europe - 2022 outbreak. Travel Med Infect Dis 2024; 59:102719. [PMID: 38574784 DOI: 10.1016/j.tmaid.2024.102719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 03/29/2024] [Accepted: 03/30/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND The aim of the study was to assess socio-demographical characteristics, clinical presentation, and outcomes in patients diagnosed with mpox. METHODS A survey on patients diagnosed with mpox was performed in 14 countries from Central and Eastern Europe. Data was compared according to HIV status and country of origin (EU vs. non-EU). Mpox diagnosis was confirmed by RT-PCR from oropharyngeal swabs, skin lesions, and other body fluids. RESULTS Out of 154 patients confirmed with mpox in 2022, 99.3% were males, with a median age (years) of 35 (IQR 30-39), 90.2% MSM and 48.7% PLWH. Compared to HIV-negative subjects, PLWH had more frequent high-risk behaviours:chemsex (p = 0.015), group sex (p = 0.027), and a history of sexually transmitted infections (STIs) (p = 0.004). Persons from EU were more often PLWH (p = 0.042), MSM (p < 0.0001), had multiple sexual partners (p = 0.025), practiced chemsex (p = 0.008) or group-sex (p = 0.005) and had more often history of STIs (p < 0.0001). The median CD4 cell count/mL at mpox diagnosis was 713 (IQR 486-996) and 73.5% had undetectable HIV VL. The commonest clinical features were fever (108 cases), lymphadenopathy (78), and vesiculo-pustular rash: penile (76), perianal (48), limbs (67). Fifty-one (31%) persons were hospitalized due to complications or epidemiological reasons. Three patients received tecovirimat or cidofovir. The outcome was favorable for all patients, including 4 with severe forms. CONCLUSIONS Mpox was diagnosed predominantly in young MSM, with high-risk behaviors and history of STIs. Effective contact tracing and vaccination are important strategic pillars to control mpox outbreaks.
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Affiliation(s)
- Irina Ianache
- Victor Babes Hospital for Infectious and Tropical Diseases, Bucharest, Romania; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Agata Skrzat-Klapaczynska
- Department of Adults' Infectious Diseases, Hospital for Infectious Diseases, Medical University of Warsaw, Poland
| | - David Jilich
- Department of Infectious Diseases, 1st Faculty of Medicine, Charles University in Prague and Faculty Hospital Bulovka, Czech Republic
| | - Lukas Fleischhans
- Department of Infectious Diseases, 1st Faculty of Medicine, Charles University in Prague and Faculty Hospital Bulovka, Czech Republic
| | - Ivana Gmizic
- Clinic for Infectious and Tropical Diseases, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Jovan Ranin
- Clinic for Infectious and Tropical Diseases, University Clinical Centre of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Serbia
| | - Antonios Papadopoulos
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Greece
| | | | - Velida Mulabdic
- Clinic for Infectious Diseases, Clinical Center University of Sarajevo, Bosnia and Herzegovina
| | - Botond Lakatos
- National Institute of Hematology and Infectious Diseases, National Center of HIV, Budapest, Hungary
| | - Eva Livia Nagy
- National Institute of Hematology and Infectious Diseases, National Center of HIV, Budapest, Hungary
| | - Josip Begovac
- University Hospital for Infectious Diseases, Zagreb, Croatia
| | - Tiberiu Holban
- Nicolae Testemitanu Medical and Pharmaceutical State University, Chișinău, Republic of Moldova
| | | | - Alma Cicic
- Centre for Communicable Diseases Control and Prevention Institute for Public Health, Podgorica, Montenegro
| | - Nina Yancheva
- Medical University of Sofia, Specialized Hospital for Infectious and Parasitic Diseases, Sofia, Bulgaria
| | | | - Nino Rukhadze
- Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia
| | - Justyna Kowalska
- Department of Adults' Infectious Diseases, Hospital for Infectious Diseases, Medical University of Warsaw, Poland
| | - Cristiana Oprea
- Victor Babes Hospital for Infectious and Tropical Diseases, Bucharest, Romania; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
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Slavec A, Iwanowska M, Bałandynowicz-Panfil K, Olah Ș, Zvonar MŠ, Štebe J, Łosiewicz M. Determinants of COVID-19 vaccination intention in Central and Eastern Europe: A cross-sectional study in Poland, Romania, and Slovenia. Arch Public Health 2024; 82:60. [PMID: 38689314 PMCID: PMC11061955 DOI: 10.1186/s13690-024-01261-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 02/28/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Identifying predictors of vaccination intention is critical to developing appropriate programs and campaigns targeting groups reluctant to be vaccinated. This study aimed to identify the determinants of vaccination intention at the beginning of the COVID-19 pandemic in three Central and Eastern European (CEE) countries: Poland, Romania, and Slovenia. METHODS In this cross-sectional study, a sample of unvaccinated 1723 Poles, Romanians, and Slovenians completed an online survey (April 2021). Questions included measures of vaccination intention, attitudes towards vaccines, conspiracy mindset, preference for a type of vaccine, and trust in information sources. RESULTS The results showed that mistrust of vaccine benefits and concerns about commercial profiteering negatively predicted vaccination intention. Conversely, trust in information from medical professionals and scientists, official sources, and traditional media was positively related to vaccination intention, while trust in digital media was negatively related to vaccination intention. In addition, preference for mRNA vaccine type was a positive significant predictor of vaccination intention. The differences between countries are discussed. CONCLUSIONS The study results deliver suggestions for developing appropriate vaccine uptake programs and campaigns that should consider presenting the positive outcomes of vaccines via official sources and traditional media based on scientific evidence and medical professionals' knowledge.
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Affiliation(s)
- Ana Slavec
- InnoRenew CoE, Izola, Slovenia and Faculty of Mathematics, Natural Sciences and Information Technologies, University of Primorska, Koper, Slovenia
| | - Magdalena Iwanowska
- Institute of Psychology, Faculty of Social Sciences, University of Gdańsk, Gdańsk, Poland.
| | | | - Șerban Olah
- Department of Sociology and Social Work, University of Oradea, Oradea, Romania
| | | | - Janez Štebe
- Social Science Data Archives (ADP), Faculty of Social Sciences, University of Ljubljana, Ljubljana, Slovenia
| | - Małgorzata Łosiewicz
- Institute of Media, Journalism and Social Communication, Faculty of Social Sciences, University of Gdańsk, Gdańsk, Poland
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Kerpel-Fronius S, Gottwald M, Arányi P, Renczes G, Görbe A, Papp R, Ferdinandy P. Past and future of an IMI-PharmaTrain (IMI-PhT)-initiated multinational pharmaceutical medicine course at the Semmelweis University in Hungary. Front Pharmacol 2024; 15:1394987. [PMID: 38746014 PMCID: PMC11091365 DOI: 10.3389/fphar.2024.1394987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Accepted: 03/27/2024] [Indexed: 05/16/2024] Open
Abstract
The pharmaceutical medicine course at the Semmelweis University of Budapest, Hungary, was initiated as part of the Innovative Medicines Initiative (IMI is the main program, IMI-PharmaTrain is one of the IMI projects) Pharmaceutical Medicine Training Programs (16 IMI Call 2008/1/16). The aim was to extend training in the development of pharmaceutical medicine to those EU member states where no such education was present. The final program envisaged the development of a cooperative education supported by universities located in Central and Eastern Europe. It was considered to be the economically and scientifically most viable approach to combine the expertise from these countries to form a united teaching staff and provide education jointly for young professionals of the region. Semmelweis University was selected to manage this coordinated program. In this report, we describe the organization and functioning of this international university-based pharmaceutical medicine education project called the Cooperative European Medicines Development Course (CEMDC) and evaluate its successes and shortcomings. During the pandemic, the educational course was interrupted. The follow-on program is reorganized as a postgraduate MSc course named "Semmelweis Pharma MBA" and will be started in 2025. It will continue the established PharmaTrain educational tradition. However, it will deal in more detail with the transition from basic pharmacological to industrial research, as well as biopharmaceutical formulation and manufacturing and marketing aspects of medicines development.
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Affiliation(s)
- S. Kerpel-Fronius
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary
| | | | - P. Arányi
- Ethics Committee for Clinical Pharmacology, Medical Research Council, Budapest, Hungary
| | | | - A. Görbe
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary
| | - R. Papp
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary
| | - P. Ferdinandy
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary
- Pharmahungary Group, Szeged, Hungary
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Tóth G, Muzsik B, Szajkó A, Kerber P, Dinya E, Csákány B, Nagy ZZ, Németh J. Incidence and Mortality of Uveal Melanoma in Hungary: A Nationwide Study. Cancers (Basel) 2024; 16:931. [PMID: 38473294 DOI: 10.3390/cancers16050931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 02/18/2024] [Accepted: 02/23/2024] [Indexed: 03/14/2024] Open
Abstract
Uveal melanoma (UM) is the most common primary malignant ocular tumour in adults, although its epidemiology in Central and Eastern Europe is unclear. This study aimed to analyse the incidence and all-cause mortality of UM in Hungary. This nationwide, retrospective, longitudinal study used data from the National Health Insurance Fund and included patients aged ≥18 years who were newly diagnosed with UM (ICD-10 C69.3 or C69.4) between 1 January 2012 and 31 December 2021. Age-standardised incidence and all-cause mortality rates were calculated using European Standard Population data from 2013. We identified 88 and 70 new patients with UM in 2012 and 2021, respectively, showing an almost stable trend. Age-standardised incidence rates varied between 6.40 and 10.96/1,000,000 person-years (PYs) during the analysed period. The highest age-standardised incidence was detected among men (13.38/1,000,000 PYs) in 2015. All-cause mortality decreased from 4.72/1,000,000 PYs to 0.79/1,000,000 PYs between 2012 and 2021. In conclusion, the UM incidence rate in Hungary is comparable to European incidence rates. The incidence did not markedly change, whereas all-cause mortality decreased during the study period, but this decline could not be attributed to improved treatment modalities for primary tumours and metastatic UM.
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Affiliation(s)
- Gábor Tóth
- Department of Ophthalmology, Semmelweis University, Mária utca 39, H-1085 Budapest, Hungary
| | - Béla Muzsik
- National Directorate General for Hospitals, Diós árok 3, H-1125 Budapest, Hungary
| | - Attila Szajkó
- National Directorate General for Hospitals, Diós árok 3, H-1125 Budapest, Hungary
| | - Pál Kerber
- National Directorate General for Hospitals, Diós árok 3, H-1125 Budapest, Hungary
| | - Elek Dinya
- Institute of Digital Health Sciences, Semmelweis University, Ferenc tér 15, H-1094 Budapest, Hungary
| | - Béla Csákány
- Department of Ophthalmology, Semmelweis University, Mária utca 39, H-1085 Budapest, Hungary
| | - Zoltán Zsolt Nagy
- Department of Ophthalmology, Semmelweis University, Mária utca 39, H-1085 Budapest, Hungary
| | - János Németh
- Department of Ophthalmology, Semmelweis University, Mária utca 39, H-1085 Budapest, Hungary
- National Directorate General for Hospitals, Diós árok 3, H-1125 Budapest, Hungary
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Dowd JB, Doniec K, Zhang L, Tilstra A. US exceptionalism? International trends in midlife mortality. Int J Epidemiol 2024; 53:dyae024. [PMID: 38508869 PMCID: PMC10954513 DOI: 10.1093/ije/dyae024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 01/29/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Rising midlife mortality in the USA has raised concerns, particularly the increase in 'deaths of despair' (due to drugs, alcohol and suicide). Life expectancy is also stalling in other countries such as the UK, but how trends in midlife mortality are evolving outside the USA is less understood. We provide a synthesis of cause-specific mortality trends in midlife (25-64 years of age) for the USA and the UK as well as other high-income and Central and Eastern European (CEE) countries. METHODS We document trends in midlife mortality in the USA, UK and a group of 13 high-income countries in Western Europe, Australia, Canada and Japan, as well as seven CEE countries from 1990 to 2019. We use annual mortality data from the World Health Organization Mortality Database to analyse sex- and age-specific (25-44, 45-54 and 55-64 years) age-standardized death rates across 15 major cause-of-death categories. RESULTS US midlife mortality rates have worsened since 1990 for several causes of death including drug-related, alcohol-related, suicide, metabolic diseases, nervous system diseases, respiratory diseases and infectious/parasitic diseases. Deaths due to homicide, transport accidents and cardiovascular diseases have declined since 1990 but saw recent increases or stalling of improvements. Midlife mortality also increased in the UK for people aged 45-54 year and in Canada, Poland and Sweden among for those aged 25-44 years. CONCLUSIONS The USA is increasingly falling behind not only high-income, but also CEE countries, some of which were heavily impacted by the post-socialist mortality crisis of the 1990s. Although levels of midlife mortality in the UK are substantially lower than those in the USA overall, there are signs that UK midlife mortality is worsening relative to that in Western Europe.
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Affiliation(s)
- Jennifer Beam Dowd
- Leverhulme Centre for Demographic Science, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Nuffield College, University of Oxford, Oxford, UK
| | - Katarzyna Doniec
- Leverhulme Centre for Demographic Science, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Nuffield College, University of Oxford, Oxford, UK
| | - Luyin Zhang
- Office of Population Research, Princeton University, Princeton, USA
| | - Andrea Tilstra
- Leverhulme Centre for Demographic Science, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Nuffield College, University of Oxford, Oxford, UK
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Lee H, Kim J, Zrínyi M. Mental health effects of adult children's outmigration on older parents in Central and Eastern Europe. Aging Ment Health 2024; 28:353-359. [PMID: 37811709 DOI: 10.1080/13607863.2023.2260327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 09/11/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVE To examine the association between adult children's migration and depression among older parents in Central and Eastern Europe (CEE) and explore the role of intergenerational support in contributing to their depression. METHODS Data are from the eighth wave of the Survey of Health, Ageing and Retirement in Europe (SHARE), pooling a study sample of 11 CEE countries, with a cross-sectional design. Analysis of covariance (ANCOVA) and hierarchical linear regression were conducted using a study sample of 9133 respondents. RESULTS Older adults whose children migrated over 500 km were more likely to experience depression compared to those with no migrant child or all children within 500 km. Among intergenerational support, frequent parent-child contact mitigated the effects of migration on depression in older parents with all their children who migrated over 500 km. CONCLUSION This study suggests that older parents with migrant children over 500 km away should be considered a vulnerable population at risk for mental health in CEE countries. It is crucial for local governments and policymakers to address these challenges through improving integrated mental health and social programs for better mental health outcomes among older adults in CEE countries.
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Affiliation(s)
- Hayoung Lee
- Faculty of Health Sciences, University of Pécs, Pécs, Hungary
| | - Jaeshin Kim
- Dankook Center for Dispute Resolution, Dankook University, Yongin, South Korea
| | - Miklós Zrínyi
- Faculty of Health Sciences, University of Pécs, Pécs, Hungary
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Koblizek V, Milenkovic B, Svoboda M, Kocianova J, Holub S, Zindr V, Ilic M, Jankovic J, Cupurdija V, Jarkovsky J, Popov B, Valipour A. RETRO-POPE: A Retrospective, Multicenter, Real-World Study of All-Cause Mortality in COPD. Int J Chron Obstruct Pulmon Dis 2023; 18:2661-2672. [PMID: 38022829 PMCID: PMC10661906 DOI: 10.2147/copd.s426919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 11/09/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose The Phenotypes of COPD in Central and Eastern Europe (POPE) study assessed the prevalence and clinical characteristics of four clinical COPD phenotypes, but not mortality. This retrospective analysis of the POPE study (RETRO-POPE) investigated the relationship between all-cause mortality and patient characteristics using two grouping methods: clinical phenotyping (as in POPE) and Burgel clustering, to better identify high-risk patients. Patients and Methods The two largest POPE study patient cohorts (Czech Republic and Serbia) were categorized into one of four clinical phenotypes (acute exacerbators [with/without chronic bronchitis], non-exacerbators, asthma-COPD overlap), and one of five Burgel clusters based on comorbidities, lung function, age, body mass index (BMI) and dyspnea (very severe comorbid, very severe respiratory, moderate-to-severe respiratory, moderate-to-severe comorbid/obese, and mild respiratory). Patients were followed-up for approximately 7 years for survival status. Results Overall, 801 of 1,003 screened patients had sufficient data for analysis. Of these, 440 patients (54.9%) were alive and 361 (45.1%) had died at the end of follow-up. Analysis of survival by clinical phenotype showed no significant differences between the phenotypes (P=0.211). However, Burgel clustering demonstrated significant differences in survival between clusters (P<0.001), with patients in the "very severe comorbid" and "very severe respiratory" clusters most likely to die. Overall survival was not significantly different between Serbia and the Czech Republic after adjustment for age, BMI, comorbidities and forced expiratory volume in 1 second (hazard ratio [HR] 0.80, 95% confidence interval [CI] 0.65-0.99; P=0.036 [unadjusted]; HR 0.88, 95% CI 0.7-1.1; P=0.257 [adjusted]). The most common causes of death were respiratory-related (36.8%), followed by cardiovascular (25.2%) then neoplasm (15.2%). Conclusion Patient clusters based on comorbidities, lung function, age, BMI and dyspnea were more likely to show differences in COPD mortality risk than phenotypes defined by exacerbation history and presence/absence of chronic bronchitis and/or asthmatic features.
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Affiliation(s)
- Vladimir Koblizek
- Department of Pneumology, University Hospital, Hradec Kralove, Czech Republic
- Faculty of Medicine Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Branislava Milenkovic
- Clinic for Pulmonary Diseases, Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Michal Svoboda
- Institute of Biostatistics and Analyses Ltd., Brno, Czech Republic
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jana Kocianova
- Outpatient Department of Pneumology Alveolus, APRO MED, Ostrava, Czech Republic
| | - Stanislav Holub
- Outpatient Chest Clinic, Plicni Stredisko Teplice Ltd., Teplice, Czech Republic
| | - Vladimir Zindr
- Outpatient Chest Clinic, PNEUMO KV Ltd., Karlovy Vary, Czech Republic
| | - Miroslav Ilic
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Clinic for Tuberculosis and Interstitial Lung Diseases, PolyClinic Department, Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia
| | - Jelena Jankovic
- Clinic for Pulmonary Diseases, Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Vojislav Cupurdija
- Department of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
- Clinic for Pulmonology, University Clinical Center Kragujevac, Kragujevac, Serbia
| | - Jiri Jarkovsky
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Boris Popov
- Medicine Department, Boehringer Ingelheim Serbia d.o.o. Beograd, Belgrade, Serbia
| | - Arschang Valipour
- Karl Landsteiner Institute for Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Vienna Health Care Group, Vienna, Austria
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Hofmarcher T, Szilagyiova P, Gustafsson A, Dolezal T, Rutkowski P, Baxter C, Karamousouli E. Access to novel cancer medicines in four countries in Central and Eastern Europe in relation to clinical benefit. ESMO Open 2023; 8:101593. [PMID: 37413761 PMCID: PMC10485399 DOI: 10.1016/j.esmoop.2023.101593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/31/2023] [Accepted: 06/02/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND Almost 100 novel cancer medicines have been approved in Europe over the last decade. Limited public health care resources in countries in Central and Eastern Europe (CEE) call for a prioritization of access to effective medicines. We investigated how both reimbursement status and waiting time to reimbursement correlate with the magnitude of clinical benefit provided by novel medicines in four selected countries (Czechia, Hungary, Poland, and Slovakia). MATERIALS AND METHODS A total of 124 indications of 51 cancer medicines with marketing authorization by the European Medicines Agency in 2011-2020 were included and followed up until 2022. Data on reimbursement status and waiting time to reimbursement (i.e. time from marketing authorization to national reimbursement approval) were collected for each country. Data were analyzed in relation to clinical benefit status (i.e. substantial versus nonsubstantial clinical benefit) of indications according to the European Society for Medical Oncology Magnitude of Clinical Benefit Scale (ESMO-MCBS). RESULTS The degree of reimbursement differed between countries with 64% of indications with reimbursement in Czechia, 40% in Hungary, 51% in Poland, and 19% in Slovakia. In all countries, a significantly greater proportion of indications with a substantial clinical benefit was reimbursed (P < 0.05). The median waiting time to reimbursement ranged from 27 months in Poland to 37 months in Hungary. No significant differences in waiting time in relation to clinical benefit were observed in any country (P = 0.25-0.84). CONCLUSIONS Cancer medicines with a substantial clinical benefit are more likely to be reimbursed in all four CEE countries. Waiting times to reimbursement are equally long for medicines with or without a substantial clinical benefit, indicating a lack of prioritization of fast access to medicines delivering a substantial benefit. Incorporation of the ESMO-MCBS in reimbursement assessments and decisions could aid in better utilization of limited resources to deliver more effective cancer care.
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Affiliation(s)
- T Hofmarcher
- IHE - The Swedish Institute for Health Economics, Lund, Sweden.
| | | | - A Gustafsson
- IHE - The Swedish Institute for Health Economics, Lund, Sweden
| | - T Dolezal
- Value Outcomes s.r.o., Praha 2, Czech Republic
| | - P Rutkowski
- Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
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Aimla K, Kowalska JD, Matulionyte R, Mulabdic V, Vassilenko A, Bolokadze N, Jilich D, Antoniak S, Oprea C, Balayan T, Harxhi A, Papadopoulos A, Lakatos B, Vasylyev M, Begovac J, Yancheva N, Streinu-Cercel A, Verhaz A, Gokengin D, Dragovic G, Sojak L, Skrzat-Klapaczyńska A. Vaccination against HBV and HAV as Mode of Hepatitis Prevention among People Living with HIV-Data from ECEE Network Group. Vaccines (Basel) 2023; 11:vaccines11050980. [PMID: 37243084 DOI: 10.3390/vaccines11050980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 04/27/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
(1) Background: Viral hepatitis C (HCV) and viral hepatitis B (HBV) are common co-infections in people living with HIV (PLWH). All PLWH should be vaccinated against HBV and hepatitis A (HAV) and treated for HBV and HCV. We aimed to compare testing, prophylaxis and treatment of viral hepatitis in PLWH in Central and Eastern Europe (CEE) in 2019 and 2022. (2) Methods: Data was collected through two on-line surveys conducted in 2019 and 2022 among 18 countries of the Euroguidelines in CEE (ECEE) Network Group. (3) Results: In all 18 countries the standard of care was to screen all PLWH for HBV and HCV both years; screening of HAV was routine in 2019 in 54.5% and in 2022 47.4% of clinics. Vaccination of PLWH against HAV was available in 2019 in 16.7%, in 2022 in 22.2% countries. Vaccination against HBV was available routinely and free of charge in 50% of clinics both in 2019 and 2022. In HIV/HBV co-infected the choice of NRTI was tenofovir-based in 94.4% of countries in both years. All clinics that responded had access to direct-acting antivirals (DAAs) but 50% still had limitations for treatment. (4) Conclusions: Although testing for HBV and HCV was good, testing for HAV is insufficient. Vaccination against HBV and especially against HAV has room for improvement; furthermore, HCV treatment access needs to overcome restrictions.
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Affiliation(s)
- Kerstin Aimla
- Department of Infectious Diseases, Tartu University Hospital, 50406 Tartu, Estonia
| | - Justyna Dominika Kowalska
- Department of Adults' Infectious Diseases, Hospital for Infectious Diseases, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Raimonda Matulionyte
- Department of Infectious Diseases and Dermatovenerology, Faculty of Medicine, Vilnius University, Vilnius University Hospital Santaros Klinikos, LT-08410 Vilnius, Lithuania
| | - Velida Mulabdic
- Clinic for Infectious Diseases, University Clinical Center Sarajevo, 71000 Sarajevo, Bosnia and Herzegovina
| | - Anna Vassilenko
- City Clinical Hospital of Infectious Diseases, 220002 Minsk, Belarus
| | - Natalie Bolokadze
- Infectious Diseases, AIDS and Clinical Immunology Research Center, 0160 Tbilisi, Georgia
| | - David Jilich
- Department of Infectious Diseases, 1st Faculty of Medicine, Charles University in Prague and Faculty Hospital Bulovka, 18000 Prague, Czech Republic
| | - Sergii Antoniak
- Clinic of the Gromashevsky Institute of Epidemiology and Infectious Diseases, 01001 Kyiv, Ukraine
| | - Cristiana Oprea
- Victor Babes Clinical Hospital for Infectious and Tropical Diseases, 030303 Bucharest, Romania
| | | | - Arjan Harxhi
- Department of Infectious Disease, Faculty of Medicine, Medical University of Tirana, 1000 Tirana, Albania
| | - Antonios Papadopoulos
- HIV Unit, 4th Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, 12462 Athens, Greece
| | - Botond Lakatos
- National Instititue of Hematology and Infectious Diseases, National Center of HIV, 1097 Budapest, Hungary
| | - Marta Vasylyev
- Lviv Regional Public Health Center, HIV Unit, 79000 Lviv, Ukraine
| | - Josip Begovac
- University Hospital of Infectious Diseases, 10000 Zagreb, Croatia
| | - Nina Yancheva
- Department for AIDS, Specialized Hospital for Active Treatment of Infectious and Parasitic Diseases, Medical University of Sofia, 1606 Sofia, Bulgaria
| | - Anca Streinu-Cercel
- National Institute of Infectious Diseases "Prof. Dr. Matei Balș", 021105 Bucharest, Romania
| | - Antonija Verhaz
- Clinic for Infectious Diseases Republic of Srpska Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina
| | - Deniz Gokengin
- Department of Infectious Diseases and Clinical Microbiology, Medical Faculty, Ege University, 35100 Izmir, Turkey
| | - Gordana Dragovic
- Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Lubomir Sojak
- Department of Infectology and Geographical Medicine, 833 05 Bratislava, Slovakia
| | - Agata Skrzat-Klapaczyńska
- Department of Adults' Infectious Diseases, Hospital for Infectious Diseases, Medical University of Warsaw, 02-091 Warsaw, Poland
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Bem R, Chadwick P, Cvjetko I, Koliba M, Kokeny Z, Lipinski P, Mrozikiewicz-Rakowska B, Rozsos I, Wegrzynowski A. A new algorithm for the management of diabetic foot ulcer: recommendations from Central and Eastern Europe. J Wound Care 2023; 32:264-272. [PMID: 37094925 DOI: 10.12968/jowc.2023.32.5.264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
There is wide regional variation in clinical practice and access to treatment for patients with diabetic foot ulcer (DFU) from countries in Central and Eastern Europe (CEE). A treatment algorithm that reflects current treatment practices while providing a common framework may facilitate best practice in DFU management and improve outcomes across the CEE region. Following a series of regional advisory board meetings with experts from Poland, the Czech Republic, Hungary and Croatia, we present consensus recommendations for the management of DFU and outline the key features of a unified algorithm for dissemination and use as a quick tool in clinical practice in CEE. The algorithm should be accessible to specialists as well as non-specialist clinicians and should incorporate: patient screening; checkpoints for assessment and referral; triggers of treatment change; and strategies for infection control, wound bed preparation and offloading. Among adjunctive treatments in DFU, there is a clear role for topical oxygen therapy, which can be used concomitantly with most existing treatment regimens in hard-to-heal wounds following standard of care. Countries from CEE face a number of challenges in the management of DFU. It is hoped that such an algorithm will help standardise the approach to DFU management and overcome some of these challenges. Ultimately, a regionwide treatment algorithm in CEE has the potential to improve clinical outcomes and save limbs.
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Affiliation(s)
- Robert Bem
- Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | | | | | | | - Zoltan Kokeny
- Outpatient Office of Jahn Ferenc Hospital, Budapest, Hungary
| | | | - Beata Mrozikiewicz-Rakowska
- Endocrinology Department, Medical Centre of Postgraduate Education, Ul. Marymoncka 99/103, 01-813 Warszawa, Poland
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Németh B, Kamusheva M, Mitkova Z, Petykó ZI, Zemplényi A, Dimitrova M, Tachkov K, Balkányi L, Czech M, Dawoud D, Goettsch W, Hren R, Knies S, Lorenzovici L, Maravic Z, Piniazhko O, Zerovnik S, Kaló Z. Guidance on using real-world evidence from Western Europe in Central and Eastern European health policy decision making. J Comp Eff Res 2023; 12:e220157. [PMID: 36861458 PMCID: PMC10402755 DOI: 10.57264/cer-2022-0157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 02/14/2023] [Indexed: 03/03/2023] Open
Abstract
Aim: Real-world data and real-world evidence (RWE) are becoming more important for healthcare decision making and health technology assessment. We aimed to propose solutions to overcome barriers preventing Central and Eastern European (CEE) countries from using RWE generated in Western Europe. Materials & methods: To achieve this, following a scoping review and a webinar, the most important barriers were selected through a survey. A workshop was held with CEE experts to discuss proposed solutions. Results: Based on survey results, we selected the nine most important barriers. Multiple solutions were proposed, for example, the need for a European consensus, and building trust in using RWE. Conclusion: Through collaboration with regional stakeholders, we proposed a list of solutions to overcome barriers on transferring RWE from Western Europe to CEE countries.
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Affiliation(s)
| | - Maria Kamusheva
- Department of Organization & Economics of Pharmacy, Faculty of Pharmacy, Medical University of Sofia, Sofia, BG 1000, Bulgaria
| | - Zornitsa Mitkova
- Department of Organization & Economics of Pharmacy, Faculty of Pharmacy, Medical University of Sofia, Sofia, BG 1000, Bulgaria
| | | | - Antal Zemplényi
- Syreon Research Institute, Budapest, HU 1142, Hungary
- Center for Health Technology Assessment & Pharmacoeconomics Research, Faculty of Pharmacy, University of Pécs, Pécs, Hungary
| | - Maria Dimitrova
- Department of Organization & Economics of Pharmacy, Faculty of Pharmacy, Medical University of Sofia, Sofia, BG 1000, Bulgaria
| | - Konstantin Tachkov
- Department of Organization & Economics of Pharmacy, Faculty of Pharmacy, Medical University of Sofia, Sofia, BG 1000, Bulgaria
| | - László Balkányi
- Medical Informatics R&D Center, Pannon University, Veszprém, HU 8200, Hungary
| | - Marcin Czech
- Department of Pharmacoeconomics, Institute of Mother & Child, Warsaw, PL 01-211, Poland
| | - Dalia Dawoud
- Science Policy & Research Programme, Science Evidence & Analytics Directorate, National Institute for Health & Care Excellence (NICE), London, United Kingdom
- Cairo University, Faculty of Pharmacy, Cairo, Egypt
| | - Wim Goettsch
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands
- National Health Care Institute, Diemen, NL 1120 AH, The Netherlands
| | - Rok Hren
- Faculty of Mathematics & Physics, University of Ljubljana, Ljubljana, Slovenia
| | - Saskia Knies
- National Health Care Institute, Diemen, NL 1120 AH, The Netherlands
| | - László Lorenzovici
- Syreon Research Romania, Tirgu Mures, RO 540004, Romania
- G. E. Palade University of Medicine, Pharmacy, Science & Technology, Tirgu Mures, RO 540142, Romania
| | | | - Oresta Piniazhko
- HTA Department of State Expert Centre of the Ministry of Health of Ukraine, Kyiv, Ukraine
| | | | - Zoltán Kaló
- Syreon Research Institute, Budapest, HU 1142, Hungary
- Centre for Health Technology Assessment, Semmelweis University, Budapest, HU 1091 Hungary
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12
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Narayan SW, Rehman MU, Ren YS, Ma C. Is a correlation-based investment strategy beneficial for long-term international portfolio investors? Financ Innov 2023; 9:64. [PMID: 36915650 PMCID: PMC9995254 DOI: 10.1186/s40854-023-00471-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 02/22/2023] [Indexed: 06/18/2023]
Abstract
UNLABELLED Using negative to low-correlated assets to manage short-term portfolio risk is not uncommon among investors, although the long-term benefits of this strategy remain unclear. This study examines the long-term benefits of the correlation strategy for portfolios based on the stock market in Asia, Central and Eastern Europe, the Middle East and North Africa, and Latin America from 2000 to 2016. Our strategy is as follows. We develop five portfolios based on the average unconditional correlation between domestic and foreign assets from 2000 to 2016. This yields five regional portfolios based on low to high correlations. In the presence of selected economic and financial conditions, long-term diversification gains for each regional portfolio are evaluated using a panel cointegration-based testing method. Consistent across all portfolios and regions, our key cointegration results suggest that selecting a low-correlated portfolio to maximize diversification gains does not necessarily result in long-term diversification gains. Our empirical method, which also permits the estimation of cointegrating regressions, provides the opportunity to evaluate the impact of oil prices, U.S. stock market fluctuations, and investor sentiments on regional portfolios, as well as to hedge against these fluctuations. Finally, we extend our data to cover the years 2017-2022 and find that our main findings are robust. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1186/s40854-023-00471-9.
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Affiliation(s)
| | - Mobeen Ur Rehman
- Shaheed Zulfikar Ali Bhutto Institute of Science and Technology (SZABIST), Islamabad, Pakistan
- South Ural State University, 76 Lenin Prospekt, Chelyabinsk, Russian Federation
| | - Yi-Shuai Ren
- School of Public Administration, Hunan University, Changsha, China
- Research Institute of Digital Society and Blockchain, Hunan University, Changsha, China
- Centre for Resource and Environmental Management, Hunan University, Changsha, China
- The Energy Centre, University of Auckland, Auckland, New Zealand
| | - Chaoqun Ma
- Research Institute of Digital Society and Blockchain, Hunan University, Changsha, China
- Centre for Resource and Environmental Management, Hunan University, Changsha, China
- Business School, Hunan University, Changsha, China
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13
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Gokengin D, Bursa D, Skrzat-Klapaczynska A, Alexiev I, Arsikj E, Balayan T, Begovac J, Cicic A, Dragovic G, Harxhi A, Aimla K, Lakatos B, Matulionyte R, Mulabdic V, Oprea C, Papadopoulos A, Rukhadze N, Sedlacek D, Sojak L, Tomazic J, Vassilenko A, Vasylyev M, Verhaz A, Yancheva N, Yurin O, Kowalska J. PrEP Scale-Up and PEP in Central and Eastern Europe: Changes in Time and the Challenges We Face with No Expected HIV Vaccine in the near Future. Vaccines (Basel) 2023; 11:vaccines11010122. [PMID: 36679967 PMCID: PMC9867039 DOI: 10.3390/vaccines11010122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/19/2022] [Accepted: 12/22/2022] [Indexed: 01/06/2023] Open
Abstract
With no expected vaccine for HIV in the near future, we aimed to define the current situation and challenges for pre- and post-exposure prophylaxis (PrEP and PEP) in Central and Eastern Europe (CEE). The Euroguidelines CEE Network Group members were invited to respond to a 27-item survey including questions on PrEP (response rate 91.6%). PrEP was licensed in 68.2%; 95 centers offered PrEP and the estimated number on PrEP was around 9000. It was available in daily (40.1%), on-demand (13.3%), or both forms (33.3%). The access rate was <1−80%. Three major barriers for access were lack of knowledge/awareness among people who are in need (59.1%), not being reimbursed (50.0%), and low perception of HIV risk (45.5%). Non-occupational PEP was available in 86.4% and was recommended in the guidelines in 54.5%. It was fully reimbursed in 36.4%, only for accidental exposures in 40.9%, and was not reimbursed in 22.72%. Occupational PEP was available in 95.5% and was reimbursed fully. Although PrEP scale-up in the region has gained momentum, a huge gap exists between those who are in need of and those who can access PrEP. Prompt action is required to address the urgent need for PrEP scale-up in the CEE region.
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Affiliation(s)
- Deniz Gokengin
- Department of Infectious Diseases and Clinical Microbiology, Medical Faculty, Ege University, Izmir 35100, Türkiye
- HIV/AIDS Research and Practice Center, Ege University, Izmir 35100, Türkiye
- Correspondence: or
| | - Dominik Bursa
- Department of Adults’ Infectious Diseases, Hospital for Infectious Diseases, Medical University of Warsaw, 01-201 Warsaw, Poland
| | - Agata Skrzat-Klapaczynska
- Department of Adults’ Infectious Diseases, Hospital for Infectious Diseases, Medical University of Warsaw, 01-201 Warsaw, Poland
| | - Ivailo Alexiev
- Department of Virology, National Center of Infectious and Parasitic Diseases, 1504 Sofia, Bulgaria
| | - Elena Arsikj
- University Clinic for Infectious Diseases and Febrile Conditions Skopje, Faculty of Medicine Skopje, Ss.Cyril and Methodius University, 1010 Skopje, North Macedonia
| | - Tatevik Balayan
- National Center for Disease Control and Prevention, Yerevan 0025, Armenia
| | - Josip Begovac
- Department of Infectious Diseases, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Alma Cicic
- Center for Communicable Disease Control and Prevention, Institute for Public Health of Montenegro, 81000 Podgorica, Montenegro
| | - Gordana Dragovic
- Department of Pharmacology, Clinical Pharmacology and Toxicology, School of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Arjan Harxhi
- Department of Infectious Disease, Faculty of Medicine, University Hospital Center of Tirana, 1001 Tirana, Albania
| | - Kerstin Aimla
- Department of Infectious Diseases, Tartu University Hospital, 50406 Tartu, Estonia
| | - Botond Lakatos
- Department of HIV and Tropical Diseases, South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, 1097 Budapest, Hungary
| | - Raimonda Matulionyte
- Department of Infectious Diseases and Dermatovenerology, Vilnius University Hospital Santaros Klinikos, Vilnius University, LT-08410 Vilnius, Lithuania
| | - Velida Mulabdic
- Clinic for Infectious Diseases, Clinical Center University of Sarajevo, 71000 Sarajevo, Bosnia and Herzegovina
| | - Cristiana Oprea
- Victor Babes Hospital for Infectious and Tropical Diseases, Carol Davila University of Medicine and Pharmacy, 030303 Bucharest, Romania
| | - Antonios Papadopoulos
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, University General Hospital “ATTIKON”, 12462 Athens, Greece
| | - Nino Rukhadze
- Infectious Diseases, AIDS & Clinical Immunology Research Center, 0160 Tbilisi, Georgia
| | - Dalibor Sedlacek
- HIV Center University Hospital, Charles University, 11000 Pilsen, Czech Republic
| | - Lubomir Sojak
- Center for Treatment of HIV/AIDS Patients, Department of Infectology and Geographical Medicine, Academic L. Derer’s University Hospital, 2412 Bratislava, Slovakia
| | - Janez Tomazic
- Department of Infectious Diseases, University Medical Center Ljubljana, 1525 Ljubljana, Slovenia
| | - Anna Vassilenko
- Global Fund Grant Management Department, Republican Scientific and Practical Center of Medical Technologies, Informatization, Management and Economics of Public Health (RNPT MT), 220013 Minsk, Belarus
| | - Marta Vasylyev
- Astar Medical Center, 79054 Lviv, Ukraine
- Internal Medicine Department, Erasmus MC, 2040 3000 Rotterdam, The Netherlands
| | - Antonija Verhaz
- Clinic for Infectious Diseases, University Clinical Center of the Republic of Srpska, 78000 Banja Luka, Bosnia and Herzegovina
| | - Nina Yancheva
- Department for AIDS, Specialized Hospital for Active Treatment of Infectious and Parasitic Diseases—Sofia, Medical University Sofia, 1431 Sofia, Bulgaria
| | - Oleg Yurin
- Department of AIDS, Epidemiology and Prevention, Central Research Institute of Epidemiology, Federal AIDS Centre, 111123 Moscow, Russia
| | - Justyna Kowalska
- Department of Adults’ Infectious Diseases, Hospital for Infectious Diseases, Medical University of Warsaw, 01-201 Warsaw, Poland
- HIV Out-Patient Clinic, Hospital for Infectious Diseases, Medical University of Warsaw, 01-201 Warsaw, Poland
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14
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Zielinski CC, Cufer T, Seruga B, Jassem J, Dediu M, Thallinger C. Perspectives for Cancer Care and Research in Central and Eastern Europe. Oncol Res Treat 2023; 46:80-88. [PMID: 36463856 PMCID: PMC10015746 DOI: 10.1159/000528487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 10/24/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND Discrepancies between the outcomes of cancer patients between Western European and Central and Eastern European (CEE) countries have often been observed. Despite the enormous economic and civilizational progress made in these countries after the abolishment of the communist regime, structural problems persist. SUMMARY The present article reviews the domains of medical oncology education, human resources in oncology, cancer care, and clinical research in CEE in order to comprehensively assess the current situation and needs, describe important initiatives, and also propose ways to improving cancer outcomes in the region. Activities are under way to address these issues in national action plans to divert funding into oncology-related education, research, the purchase of equipment, and the attainment of modern hospital organization and structures. KEY MESSAGE Over the past more than 30 years, CEE countries have made enormous economic and societal progress. Nevertheless, challenges especially in the health care sector persist.
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Affiliation(s)
- Christoph C Zielinski
- Wiener Privatklinik, Central European Academy Cancer Center, Vienna, Austria.,Central European Cooperative Oncology Group, Vienna, Austria
| | - Tanja Cufer
- Medical Faculty, University of Ljubljana, Slovenia, Ljubljana, Slovenia
| | - Bostjan Seruga
- Medical Oncology Department, SANADOR Oncology Center, Bucharest, Romania
| | - Jacek Jassem
- Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | - Mircea Dediu
- Division of Medical Oncology, Institute of Oncology Ljubljana and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Christiane Thallinger
- Central European Cooperative Oncology Group, Vienna, Austria.,Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
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15
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Zemplényi A, Tachkov K, Balkanyi L, Németh B, Petykó ZI, Petrova G, Czech M, Dawoud D, Goettsch W, Gutierrez Ibarluzea I, Hren R, Knies S, Lorenzovici L, Maravic Z, Piniazhko O, Savova A, Manova M, Tesar T, Zerovnik S, Kaló Z. Recommendations to overcome barriers to the use of artificial intelligence-driven evidence in health technology assessment. Front Public Health 2023; 11:1088121. [PMID: 37181704 PMCID: PMC10171457 DOI: 10.3389/fpubh.2023.1088121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 04/03/2023] [Indexed: 05/16/2023] Open
Abstract
Background Artificial intelligence (AI) has attracted much attention because of its enormous potential in healthcare, but uptake has been slow. There are substantial barriers that challenge health technology assessment (HTA) professionals to use AI-generated evidence for decision-making from large real-world databases (e.g., based on claims data). As part of the European Commission-funded HTx H2020 (Next Generation Health Technology Assessment) project, we aimed to put forward recommendations to support healthcare decision-makers in integrating AI into the HTA processes. The barriers, addressed by the paper, are particularly focusing on Central and Eastern European (CEE) countries, where the implementation of HTA and access to health databases lag behind Western European countries. Methods We constructed a survey to rank the barriers to using AI for HTA purposes, completed by respondents from CEE jurisdictions with expertise in HTA. Using the results, two members of the HTx consortium from CEE developed recommendations on the most critical barriers. Then these recommendations were discussed in a workshop by a wider group of experts, including HTA and reimbursement decision-makers from both CEE countries and Western European countries, and summarized in a consensus report. Results Recommendations have been developed to address the top 15 barriers in areas of (1) human factor-related barriers, focusing on educating HTA doers and users, establishing collaborations and best practice sharing; (2) regulatory and policy-related barriers, proposing increasing awareness and political commitment and improving the management of sensitive information for AI use; (3) data-related barriers, suggesting enhancing standardization and collaboration with data networks, managing missing and unstructured data, using analytical and statistical approaches to address bias, using quality assessment tools and quality standards, improving reporting, and developing better conditions for the use of data; and (4) technological barriers, suggesting sustainable development of AI infrastructure. Conclusion In the field of HTA, the great potential of AI to support evidence generation and evaluation has not yet been sufficiently explored and realized. Raising awareness of the intended and unintended consequences of AI-based methods and encouraging political commitment from policymakers is necessary to upgrade the regulatory and infrastructural environment and knowledge base required to integrate AI into HTA-based decision-making processes better.
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Affiliation(s)
- Antal Zemplényi
- Center for Health Technology Assessment and Pharmacoeconomics Research, Faculty of Pharmacy, University of Pécs, Pécs, Hungary
- Syreon Research Institute, Budapest, Hungary
- *Correspondence: Antal Zemplényi,
| | - Konstantin Tachkov
- Department of Organization and Economics of Pharmacy, Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria
| | - Laszlo Balkanyi
- Medical Informatics R&D Center, Pannon University, Veszprém, Hungary
| | | | | | - Guenka Petrova
- Department of Organization and Economics of Pharmacy, Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria
| | - Marcin Czech
- Department of Pharmacoeconomics, Institute of Mother and Child, Warsaw, Poland
| | - Dalia Dawoud
- Science Policy and Research Programme, Science Evidence and Analytics Directorate, National Institute for Health and Care Excellence (NICE), London, United Kingdom
- Cairo University, Faculty of Pharmacy, Cairo, Egypt
| | - Wim Goettsch
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, Netherlands
- National Health Care Institute, Diemen, Netherlands
| | | | - Rok Hren
- Faculty of Mathematics and Physics, University of Ljubljana, Ljubljana, Slovenia
| | - Saskia Knies
- National Health Care Institute, Diemen, Netherlands
| | - László Lorenzovici
- Syreon Research Romania, Tirgu Mures, Romania
- G. E. Palade University of Medicine, Pharmacy, Science and Technology, Tirgu Mures, Romania
| | | | - Oresta Piniazhko
- HTA Department of State Expert Centre of the Ministry of Health of Ukraine, Kyiv, Ukraine
| | - Alexandra Savova
- Department of Organization and Economics of Pharmacy, Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria
- National Council of Prices and Reimbursement of Medicinal Products, Sofia, Bulgaria
| | - Manoela Manova
- Department of Organization and Economics of Pharmacy, Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria
- National Council of Prices and Reimbursement of Medicinal Products, Sofia, Bulgaria
| | - Tomas Tesar
- Department of Organisation and Management of Pharmacy, Faculty of Pharmacy, Comenius University in Bratislava, Bratislava, Slovakia
| | | | - Zoltán Kaló
- Syreon Research Institute, Budapest, Hungary
- Centre for Health Technology Assessment, Semmelweis University, Budapest, Hungary
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Mastylak A, Miteniece E, Czabanowska K, Pavlova M, Groot W. The "Blessing" of Pregnancy? Barriers to accessing adequate maternal care in Poland: A mixed-method study among women, healthcare providers, and decision-makers. Midwifery 2023; 116:103554. [PMID: 36410258 DOI: 10.1016/j.midw.2022.103554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 10/10/2022] [Accepted: 11/11/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE All women should have access to adequate and respectful maternal care to maximise health outcomes. In Poland, there is a mismatch between good maternal health indicators and poor care experiences. This study examined stakeholder views on access to adequate maternal care in Poland in terms of availability, appropriateness, affordability, approachability, and acceptability. DESIGN A mixed-methods study. SETTING Online survey and online semi-structured interviews conducted between March 2021 and May 2021. PARTICIPANTS Five-hundred fifty-seven (557) women who recently gave birth in Poland, maternal care providers and decision-makers active in the field of maternal health. FINDINGS The main barriers to adequate care were inappropriate communication of maternal care providers, insufficient compliance with standards of care, over-medicalisation of childbirth and suboptimal engagement of women in care provision, and high levels of out-of-pocket spending on maternal care services. Other barriers included limited availability of maternal care providers, particularly midwives, and low reproductive health literacy in women. KEY CONCLUSIONS Provision of adequate and women-centred maternal care remains erratic, despite substantial care provision advancements in recent years. Addressing the barriers could substantially improve the experience of and access to adequate maternal care in Poland. IMPLICATIONS FOR PRACTICE Barriers identified in the survey with women largely converged with those highlighted in the interviews. In addition, maternal care providers and decision-makers provided context-specific information and explanation of the current state of maternal care system. Consequently, this study provides direction-setting information for policy and practice in Poland and other Central and Eastern European countries, which share similar shortcomings related to adequate maternal care provision.
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Affiliation(s)
- Alicja Mastylak
- Department of International Health, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands.
| | - Elina Miteniece
- Research Center for Midwifery Science, Academic Verloskunde Maastricht, Zuyd, the Netherlands.
| | - Katarzyna Czabanowska
- Department of International Health, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands; Department of Health Policy Management, Institute of Public Health, Faculty of Health Care, Jagiellonian University, Krakow, Poland.
| | - Milena Pavlova
- Department of Health Services Research, School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands.
| | - Wim Groot
- Department of Health Services Research, School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands; Top Institute Evidence-based Education Research (TIER), Maastricht University, Maastricht, Netherlands.
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17
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Callenbach MHE, Ádám L, Vreman RA, Németh B, Kaló Z, Goettsch WG. Reimbursement and payment models in Central and Eastern European as well as Middle Eastern countries: A survey of their current use and future outlook. Drug Discov Today 2023; 28:103433. [PMID: 36372328 DOI: 10.1016/j.drudis.2022.103433] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 09/01/2022] [Accepted: 11/03/2022] [Indexed: 11/13/2022]
Abstract
There is growing interest in innovative reimbursement and payment models in Central and Eastern European (CEE) and Middle Eastern (ME) countries. A questionnaire was sent to payers from CEE and ME countries regarding the current use of, future preferences for and perceived barriers with these models. Twenty-seven healthcare payers from 11 countries completed the survey. Results showed participants preferred using outcome-based reimbursement models and delayed payment models more often; however, currently they are rarely applied. Barriers hindering implementation were mostly related to IT and data infrastructure, measurement issues, transaction costs and the administrative burden. Given these barriers highlighted in our study, policymakers should focus on the development of an implementation framework with contract templates for the preferred reimbursement and payment schemes to aid the feasibility of a successful implementation.
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Kozela M, Polak M, Stepaniak U, Bobak M, Pająk A. Changes in Socioeconomic Status as Predictors of Cardiovascular Disease Incidence and Mortality: A 10-Year Follow-Up of a Polish-Population-Based HAPIEE Cohort. Int J Environ Res Public Health 2022; 19:15411. [PMID: 36430130 PMCID: PMC9693797 DOI: 10.3390/ijerph192215411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/17/2022] [Accepted: 11/18/2022] [Indexed: 06/16/2023]
Abstract
Although the inverse association between socioeconomic status (SES) and cardiovascular disease (CVD) is well established, research on the effect of changes in the SES throughout life on CVD risk in populations with different social backgrounds remains scarce. This study aimed to assess the relationship between childhood SES, adulthood SES, and changes in SES over time, and CVD incidence and mortality in a Polish urban population. In addition, the predictive performance of the SES index was compared with education alone. A cohort study with a 10-year follow-up was conducted, in which a random sample of 10,728 residents in Kraków aged 45-69 years were examined. The SES was assessed at baseline using data on education, parents' education, housing standard at the age of 10 years, professional activity, household amenities, and difficulties in paying bills and buying food. SES categories (low, middle, and high) were extracted using cluster analyses. Information on new CVD cases was obtained from questionnaires in subsequent phases of the study and confirmed by reviewing clinical records. Data on deaths and causes were obtained from the residents' registry, Central Statistical Office, and the participants' families. The effect of the SES index on the risk of CVD was assessed using Cox proportional hazard models. In male and female participants, the CVD incidence and mortality were observed to be 27,703 and 32,956 person-years (384 and 175 new CVD cases) and 36,219 and 40,048 person-years (159 and 92 CVD deaths), respectively. Childhood SES was not associated with CVD incidence and mortality. A protective effect of high adulthood SES against CVD mortality was observed in men and women (HR = 0.59, 95% CI = 0.31-0.97; HR = 0.33, 95% CI = 0.14-0.75, respectively). In women, downward social mobility was related to 2.24 and 3.75 times higher CVD incidence and mortality, respectively. In men, a protective effect against mortality was observed in upward mobility (HR = 0.50, 95% CI = 0.29-0.84). Model discrimination was similar for the SES index and education alone for the association with CVD incidence. In women, the SES index was a slightly better predictor of CVD mortality than education alone (C-index = 0.759, SE = 0.0282 vs. C-index = 0.783, SE = 0.0272; p = 0.041). In conclusion, high adulthood SES, but not childhood SES, may be considered to be a protective factor against CVD in urban populations in high-CVD-risk regions. No effects of critical periods in early life were observed on CVD risk. In later life, social mobility was found to affect CVD mortality in both men and women. In men, a protective effect of upward mobility was confirmed, whereas in women, an increased CVD risk was related to downward mobility. It can be concluded that CVD prevention may be beneficial if socioeconomic potentials are strengthened in later life.
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Affiliation(s)
- Magdalena Kozela
- Department of Epidemiology and Population Studies, Institute of Public Health, Jagiellonian University Medical College, 31-008 Krakow, Poland
| | - Maciej Polak
- Department of Epidemiology and Population Studies, Institute of Public Health, Jagiellonian University Medical College, 31-008 Krakow, Poland
| | - Urszula Stepaniak
- Department of Epidemiology and Population Studies, Institute of Public Health, Jagiellonian University Medical College, 31-008 Krakow, Poland
| | - Martin Bobak
- Department of Epidemiology and Public Health, University College London, London WC1E 6BT, UK
| | - Andrzej Pająk
- Department of Epidemiology and Population Studies, Institute of Public Health, Jagiellonian University Medical College, 31-008 Krakow, Poland
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Matłosz B, Skrzat-Klapaczyńska A, Antoniak S, Balayan T, Begovac J, Dragovic G, Gusev D, Jevtovic D, Jilich D, Aimla K, Lakatos B, Matulionyte R, Panteleev A, Papadopoulos A, Rukhadze N, Sedláček D, Stevanovic M, Vassilenko A, Verhaz A, Yancheva N, Yurin O, Horban A, Kowalska JD. Chronic Kidney Disease and Nephrology Care in People Living with HIV in Central/Eastern Europe and Neighbouring Countries-Cross-Sectional Analysis from the ECEE Network. Int J Environ Res Public Health 2022; 19:12554. [PMID: 36231850 PMCID: PMC9565150 DOI: 10.3390/ijerph191912554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/27/2022] [Accepted: 09/27/2022] [Indexed: 06/16/2023]
Abstract
Chronic kidney disease (CKD) is a significant cause of morbidity and mortality among patients infected with human immunodeficiency virus (HIV). The Central and East Europe (CEE) region consists of countries with highly diversified HIV epidemics, health care systems and socioeconomic status. The aim of the present study was to describe variations in CKD burden and care between countries. The Euroguidelines in the CEE Network Group includes 19 countries and was initiated to improve the standard of care for HIV infection in the region. Information on kidney care in HIV-positive patients was collected through online surveys sent to all members of the Network Group. Almost all centres use regular screening for CKD in all HIV (+) patients. Basic diagnostic tests for kidney function are available in the majority of centres. The most commonly used method for eGFR calculation is the Cockcroft-Gault equation. Nephrology consultation is available in all centres. The median frequency of CKD was 5% and the main cause was comorbidity. Haemodialysis was the only modality of treatment for kidney failure available in all ECEE countries. Only 39% of centres declared that all treatment options are available for HIV+ patients. The most commonly indicated barrier in kidney care was patients' noncompliance. In the CEE region, people living with HIV have full access to screening for kidney disease but there are important limitations in treatment. The choice of dialysis modality and access to kidney transplantation are limited. The main burden of kidney disease is unrelated to HIV infection. Patient care can be significantly improved by addressing noncompliance.
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Affiliation(s)
- Bartłomiej Matłosz
- HIV Outpatient Clinic, Hospital for Infectious Diseases, Medical University of Warsaw, 02-091 Warszawa, Poland
| | - Agata Skrzat-Klapaczyńska
- Department of Adults’ Infectious Diseases, Hospital for Infectious Diseases, Medical University of Warsaw, 02-091 Warszawa, Poland
| | - Sergii Antoniak
- Viral Hepatitis and AIDS Department, Gromashevsky Institute of Epidemiology and Infectious Diseases, 01001 Kyiv, Ukraine
| | - Tatevik Balayan
- National Center for Disease Control and Prevention, Yerevan 0002, Armenia
| | - Josip Begovac
- School of Medicine, University Hospital for Infectious Diseases, University of Zagreb, 10000 Zagreb, Croatia
| | - Gordana Dragovic
- Department of Pharmacology, Clinical Pharmacology and Toxicology, School of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Denis Gusev
- Botkin’s Infectious Disease Hospital, First Saint-Petersburg State Medical University Named after I.P. Pavlov, 197022 Saint-Petersburg, Russia
| | - Djordje Jevtovic
- Infectious Disease Hospital, Belgrade University School of Medicine, 11000 Belgrade, Serbia
| | - David Jilich
- Department of Infectious Diseases, 1st Faculty of Medicine, Charles University in Prague and Faculty Hospital Bulovka Hospital, 18000 Prague, Czech Republic
| | - Kerstin Aimla
- West Tallinn Central Hospital, 10111 Tallinn, Estonia
| | - Botond Lakatos
- National Institute of Hematology and Infectious Diseases, South-Pest Central Hospital, National Center of HIV, 1007 Budapest, Hungary
| | - Raimonda Matulionyte
- Faculty of Medicine, Vilnius University, Vilnius University Hospital Santaros Klinikos, 08410 Vilnius, Lithuania
| | | | - Antonios Papadopoulos
- University General Hospital Attikon, Medical School, National and Kapodistrian University of Athens, 15772 Athens, Greece
| | - Nino Rukhadze
- Infectious Diseases, AIDS and Clinical Immunology Center, 112482 Tblisi, Georgia
| | - Dalibor Sedláček
- Faculty of Medicine in Plzeň, University Hospital Plzeň, Charles University, 30599 Plzen, Czech Republic
| | - Milena Stevanovic
- University Clinic for Infectious Diseases and Febrile Conditions, 1000 Skopje, North Macedonia
| | - Anna Vassilenko
- Global Fund Grant Management Department, Republican Scientific and Practical Center for Medical Technologies, 220004 Minsk, Belarus
| | - Antonija Verhaz
- Department for Infectious Diseases, Faculty of Medicine, University of Banja Luka, 78 000 Banja Luka, Republika Srpska, Bosnia and Herzegovina
| | - Nina Yancheva
- Department for AIDS, Specialized Hospital for Active Treatment of Infectious and Parasitic Disease, 1000 Sofia, Bulgaria
| | - Oleg Yurin
- Central Research Institute of Epidemiology, Federal AIDS Centre, 101000 Moscow, Russia
| | - Andrzej Horban
- Department of Adults’ Infectious Diseases, Hospital for Infectious Diseases, Medical University of Warsaw, 02-091 Warszawa, Poland
| | - Justyna D. Kowalska
- Department of Adults’ Infectious Diseases, Hospital for Infectious Diseases, Medical University of Warsaw, 02-091 Warszawa, Poland
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Stepaniak U, Polak M, Stefler D, Kozela M, Bobak M, Sanchez-Niubo A, Ayuso-Mateos JL, Haro JM, Pająk A. Relationship between Dietary Macronutrients Intake and the ATHLOS Healthy Ageing Scale: Results from the Polish Arm of the HAPIEE Study. Nutrients 2022; 14:2454. [PMID: 35745184 DOI: 10.3390/nu14122454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/09/2022] [Accepted: 06/10/2022] [Indexed: 12/04/2022] Open
Abstract
Background: Despite extensive research, our knowledge on the relationship between nutrition and healthy ageing is limited. The aim of this study was to evaluate the associations between the intake of macronutrients and a single measure of healthy ageing (ATHLOS Healthy Ageing Scale). Methods: A cross-sectional analysis was performed using data from 9906 randomly selected citizens of Krakow (Poland) who were 45–69 years of age and participants of the Health, Alcohol and Psychosocial factors in Eastern Europe (HAPIEE) study. Macronutrient intake was evaluated using a food frequency questionnaire. ATHLOS Health Ageing Scale was estimated from 41 variables in pooled data from 16 cohorts. Standardized beta coefficients were estimated using multivariable linear regression models. Results: In multivariable adjusted models, there were significant positive associations between the ATHLOS Healthy Ageing Scale score and intake of protein (b = 0.030, 95% CI 0.001; 0.059 in men; b = 0.056, 95% CI 0.027; 0.085 in women), monounsaturated fatty acids (MUFA) (b = 0.042, 95% CI 0.013; 0.071 in men; b = 0.035, 95% CI 0.006; 0.064 in women), polyunsaturated fatty acids (PUFA) (b = 0.053, 95% CI 0.024; 0.082 in men; b = 0.063, 95% CI 0.034; 0.092 in women), and omega-3 PUFA (b = 0.031, 95% CI 0.002;0.060 in men; b = 0.054, 95% CI 0.026; 0.082 in women). Carbohydrate intake was inversely associated with the ATHLOS Healthy Ageing Scale in women. Total fat intake was positively associated with the ATHLOS Healthy Ageing Scale in men. Conclusions: A number of nutrients were associated with the healthy ageing score, suggesting that dietary habits may play an important role in healthy ageing. Further research in other settings and with a prospective design is strongly warranted.
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Lu W, Pikhart H, Tamosiunas A, Kubinova R, Capkova N, Malyutina S, Pająk A, Bobak M. Prevalence, awareness, treatment and control of hypertension, diabetes and hypercholesterolemia, and associated risk factors in the Czech Republic, Russia, Poland and Lithuania: a cross-sectional study. BMC Public Health 2022; 22:883. [PMID: 35508994 DOI: 10.1186/s12889-022-13260-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 04/13/2022] [Indexed: 11/12/2022] Open
Abstract
Background Empirical evidence on the epidemiology of hypertension, diabetes and hypercholesterolemia is limited in many countries in Central and Eastern Europe. We aimed to estimate the prevalence, awareness, treatment and control of hypertension, diabetes and hypercholesterolemia in the Czech Republic, Russia, Poland and Lithuania, and to identify the risk factors for the three chronic conditions. Methods We analysed cross-sectional data from the HAPIEE study, including adults aged 45–69 years in the Czech Republic, Russia, Poland and Lithuania, collected between 2002 and 2008 (total sample N = 30,882). Among prevalent cases, we estimated awareness, treatment, and control of hypertension, diabetes and hypercholesterolemia by gender and country. Multivariate logistic regression was applied to identify associated risk factors. Results In each country among both men and women, we found high prevalence but low control of hypertension, diabetes, and hypercholesterolemia. Awareness rates of hypertension were the lowest in both men (61.40%) and women (69.21%) in the Czech Republic, while awareness rates of hypercholesterolemia were the highest in both men (46.51%) and women (51.20%) in Poland. Polish participants also had the highest rates of awareness (77.37% in men and 79.53% in women), treatment (71.99% in men and 74.87% in women) and control (30.98% in men and 38.08% in women) of diabetes. The common risk factors for the three chronic conditions were age, gender, education, obesity and alcohol consumption. Conclusions Patterns of awareness, treatment and control rates of hypertension, diabetes and hypercholesterolemia differed by country. Efforts should be made in all four countries to control these conditions, including implementation of international guidelines in everyday practice to improve detection and effective management of these conditions. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13260-3.
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Rodriguez A, Korzeniowska K, Szarejko K, Borowski H, Brzeziński M, Myśliwiec M, Czupryniak L, Berggren PO, Radziwiłł M, Soszyński P. Fitness, Food, and Biomarkers: Characterizing Body Composition in 19,634 Early Adolescents. Nutrients 2022; 14:nu14071369. [PMID: 35405987 PMCID: PMC9003290 DOI: 10.3390/nu14071369] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 03/18/2022] [Accepted: 03/22/2022] [Indexed: 12/11/2022] Open
Abstract
Adolescent obesity persists as a major concern, especially in Central and Eastern Europe, yet evidence gaps exist regarding the pivotal early adolescent years. Our objective was to provide a comprehensive picture using a holistic approach of measured anthropometry in early adolescence, including body composition, cardiorespiratory fitness (CRF), and reported lifestyle characteristics. We aimed to elucidate potential sex/gender differences throughout and associations to biomarkers of disease risk for obese adolescents. Methods: Trained nurses measured 19,634 early adolescents (12−14-year-olds), we collected parental reports, and, for obese adolescents, fasting blood samples in four major Polish cities using a cross-sectional developmental design. Results: 24.7% boys and 18.6% girls were overweight/obese, and 2886 had BMI ≥ 90th percentile. With increasing age, there was greater risk of obesity among boys (p for trend = 0.001) and a decreasing risk of thinness for girls (p for trend = 0.01). Contrary to debate, we found BMI (continuous) was a useful indicator of measured fat mass (FM). There were 38.6% with CRF in the range of poor/very poor and was accounted for primarily by FM in boys, rather than BMI, and systolic blood pressure in girls. Boys, in comparison to girls, engaged more in sports (t = 127.26, p < 0.0001) and consumed more fast food (t = 188.57, p < 0.0001) and sugar-sweetened beverages (167.46, p < 0.0001). Uric acid, a potential marker for prediabetes, was strongly related to BMI in the obese subsample for both boys and girls. Obese girls showed signs of undernutrition. Conclusion: these findings show that overweight/obesity is by far a larger public health problem than thinness in early adolescence and is characterized differentially by sex/gender. Moreover, poor CRF in this age, which may contribute to life course obesity and disease, highlights the need for integrated and personalized intervention strategies taking sex/gender into account.
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Affiliation(s)
- Alina Rodriguez
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London W2 1PG, UK
- Wolfson Institute of Population Health, Queen Mary University of London, London EC1M 6BQ, UK
- Correspondence:
| | - Katarzyna Korzeniowska
- Department of Pediatrics, Diabetology and Endocrinology, Medical University of Gdansk, 80-210 Gdansk, Poland; (K.K.); (M.M.)
| | - Kamila Szarejko
- PoZdro! Program Scientific Board, Medicover Foundation, 00-807 Warszawa, Poland; (K.S.); (H.B.); (M.R.); (P.S.)
| | - Hubert Borowski
- PoZdro! Program Scientific Board, Medicover Foundation, 00-807 Warszawa, Poland; (K.S.); (H.B.); (M.R.); (P.S.)
| | - Michał Brzeziński
- Department of Pediatrics, Gastroenterology, Allergology & Nutrition, Medical University of Gdansk, 80-210 Gdansk, Poland;
| | - Małgorzata Myśliwiec
- Department of Pediatrics, Diabetology and Endocrinology, Medical University of Gdansk, 80-210 Gdansk, Poland; (K.K.); (M.M.)
| | - Leszek Czupryniak
- Department of Diabetology and Internal Diseases, Warsaw Medical University, 02-091 Warszawa, Poland;
| | - Per-Olof Berggren
- The Rolf Luft Research Center for Diabetes and Endocrinology, Karolinska Institutet, 171 77 Stockholm, Sweden;
| | - Marcin Radziwiłł
- PoZdro! Program Scientific Board, Medicover Foundation, 00-807 Warszawa, Poland; (K.S.); (H.B.); (M.R.); (P.S.)
| | - Piotr Soszyński
- PoZdro! Program Scientific Board, Medicover Foundation, 00-807 Warszawa, Poland; (K.S.); (H.B.); (M.R.); (P.S.)
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Valipour A, Aisanov Z, Avdeev S, Koblizek V, Kocan I, Kopitovic I, Lupkovics G, Man M, Bukovskis M, Tudoric N, Vukoja M, Naumnik W, Yanev N. Recommendations for COPD management in Central and Eastern Europe. Expert Rev Respir Med 2022; 16:221-234. [PMID: 35001780 DOI: 10.1080/17476348.2021.2023498] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION The Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy report provides guidance on effective management of chronic obstructive pulmonary disease (COPD) according to local healthcare systems. However, COPD is a heterogenous disease and certain aspects, including prevalence, disease-time course and phenotype distribution, can differ between countries. Moreover, features of clinical practice and healthcare systems for COPD patients can vary widely, even in geographically close and economically similar countries. AREAS COVERED Based on an initial workshop of respiratory physicians from eleven countries across Central and Eastern Europe (CEE) in December 2018 and subsequent discussions, this article offers region-specific insights from clinical practice and healthcare systems in CEE. Taking GOLD 2020 recommendations into account, we suggest approaches to adapt these into national clinical guidelines for COPD management in CEE. EXPERT OPINION Several factors should be considered when optimizing management of COPD in CEE compared with other regions, including differences in smoking status, vaccination uptake, prevalence of tuberculosis and nontuberculous mycobacteria, and variations in healthcare systems. We provide guidance and algorithms for pharmacologic and non-pharmacologic management of COPD for the following scenarios: initial and follow-up treatment, treatment of patients with frequent exacerbations, and withdrawal of inhaled corticosteroids where appropriate.
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Affiliation(s)
- Arschang Valipour
- Department of Respiratory and Critical Care Medicine, Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Vienna Health Care Group, Vienna, Austria
| | - Zaurbek Aisanov
- Department of Pulmonology, Pirogov Russian State National Research Medical University, Moscow, Russia
| | - Sergey Avdeev
- Pulmonology Department, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Vladimir Koblizek
- Department of Pneumology, Faculty of Medicine in Hradec Kralove, Charles University Hospital, Hradec Kralove, Czech Republic
| | - Ivan Kocan
- University Hospital Martin, Jessenius Faculty of Medicine, Commenius University, Martin, Slovakia
| | - Ivan Kopitovic
- Department for Respiratory Pathophysiology and Sleep Disordered Breathing, The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia.,Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Gergely Lupkovics
- Adult Pulmonary Department, Institute for Pulmonary Diseases, Törökbálint, Hungary
| | - Milena Man
- Pulmonology Department, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Maris Bukovskis
- Department of Internal Diseases, Faculty Medicine, University of Latvia, Riga, Latvia
| | - Neven Tudoric
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Marija Vukoja
- Department for Respiratory Pathophysiology and Sleep Disordered Breathing, The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia.,Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Wojciech Naumnik
- First Department of Lung Diseases and Chemotherapy of Respiratory Neoplasms, Medical University of Bialystok, Bialystok, Poland
| | - Nikolay Yanev
- Department of Pulmonary Diseases, Medical University of Sofia, Sofia, Bulgaria
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Janez A, Battelino T, Klupa T, Kocsis G, Kuricová M, Lalić N, Stoian AP, Prázný M, Rahelić D, Šoupal J, Tankova T, Zelinska N. Hybrid Closed-Loop Systems for the Treatment of Type 1 Diabetes: A Collaborative, Expert Group Position Statement for Clinical Use in Central and Eastern Europe. Diabetes Ther 2021; 12:3107-3135. [PMID: 34694585 PMCID: PMC8586062 DOI: 10.1007/s13300-021-01160-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 09/18/2021] [Indexed: 01/23/2023] Open
Abstract
In both pediatric and adult populations with type 1 diabetes (T1D), technologies such as continuous subcutaneous insulin infusion (CSII), continuous glucose monitoring (CGM), or sensor-augmented pumps (SAP) can consistently improve glycemic control [measured as glycated hemoglobin (HbA1c) and time in range (TIR)] while reducing the risk of hypoglycemia. Use of technologies can thereby improve quality of life and reduce the burden of diabetes management compared with self-injection of multiple daily insulin doses (MDI). Novel hybrid closed-loop (HCL) systems represent the latest treatment modality for T1D, combining modern glucose sensors and insulin pumps with a linked control algorithm to offer automated insulin delivery in response to blood glucose levels and trends. HCL systems have been associated with increased TIR, improved HbA1c, and fewer hypoglycemic events compared with CSII, SAP, and MDI, thereby potentially improving quality of life for people with diabetes (PwD) while reducing the costs of treating short- and long-term diabetes-related complications. However, many barriers to their use and regional inequalities remain in Central and Eastern Europe (CEE). Published data suggest that access to diabetes technologies is hindered by lack of funding, underdeveloped health technology assessment (HTA) bodies and guidelines, unfamiliarity with novel therapies, and inadequacies in healthcare system capacities. To optimize the use of diabetes technologies in CEE, an international meeting comprising experts in the field of diabetes was held to map the current regional access, to present the current national reimbursement guidelines, and to recommend solutions to overcome uptake barriers. Recommendations included regional and national development of HTA bodies, efficient allocation of resources, and structured education programs for healthcare professionals and PwD. The responsibility of the healthcare community to ensure that all individuals with T1D gain access to modern technologies in a timely and economically responsible manner, thereby improving health outcomes, was emphasized, particularly for interventions that are cost-effective.
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Affiliation(s)
- Andrej Janez
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Center Ljubljana, Zaloska 7, 1000, Ljubljana, Slovenia.
| | - Tadej Battelino
- University Medical Center Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Tomasz Klupa
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- University Hospital, Kraków, Poland
| | - Győző Kocsis
- Department of Medicine and Oncology, Semmelweis University Budapest, Budapest, Hungary
| | - Miriam Kuricová
- Pediatric Department, National Institute of Endocrinology and Diabetology, Ľubochňa, Slovakia
- Department of Children and Adolescents, Jessenius Faculty of Medicine, Comenius University Bratislava, Martin, Slovakia
| | - Nebojša Lalić
- Faculty of Medicine of the University of Belgrade, Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Belgrade, Serbia
| | - Anca Pantea Stoian
- Department of Diabetes, Nutrition and Metabolic Diseases, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Martin Prázný
- Third Department of Internal Medicine, First Faculty of Medicine, Charles University and General Faculty Hospital, Prague, Czechia
| | - Dario Rahelić
- Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
- School of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Jan Šoupal
- Third Department of Internal Medicine, First Faculty of Medicine, Charles University and General Faculty Hospital, Prague, Czechia
| | - Tsvetalina Tankova
- Department of Endocrinology, Medical University of Sofia, Sofia, Bulgaria
| | - Nataliya Zelinska
- Ukrainian Scientific and Practical Center of Endocrine Surgery, Transplantation of Endocrine Organs and Tissues of the Ministry of Health of Ukraine, Kyiv, Ukraine
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Kurpas D, Stefanicka-Wojtas D, Shpakou A, Halata D, Mohos A, Skarbaliene A, Dumitra G, Klimatckaia L, Bendova J, Tkachenko V. The Advantages and Disadvantages of Integrated Care Implementation in Central and Eastern Europe - Perspective from 9 CEE Countries. Int J Integr Care 2021; 21:14. [PMID: 34824563 DOI: 10.5334/ijic.5632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 09/20/2021] [Indexed: 12/04/2022] Open
Abstract
Introduction: Health and social care systems in Central and Eastern European (CEE) countries have undergone significant changes and are currently dealing with serious problems of system disintegration, coordination and a lack of control over the market environment. Description: The increased health needs related to the ageing society and epidemiological patterns in these countries also require funding needs to increase, rationing to be reformed, sectors to be integrated (the managed care approach), and an analytical information base to be developed if supervision of new technological approaches is to improve. The period of system transitions in CEE countries entailed significant changes in their health systems, including health care financing. Discussion: Large deficits in the public financing of health systems were just one of the challenges arising from the economic downturn of the 1990s, which was coupled with inflation, increasing unemployment, low salaries, a large informal sector and tax evasion in a number of CEE countries. During the communist period, there was universal access to a wide range of health services, proving it difficult to retain this coverage. As a result, many states sought to ration publicly funded health services – for example, through patient cost-sharing or decreasing the scope of basic benefits. Yet, not all of these reform plans were implemented, and in fact, some were rolled back or not implemented at all due to a lack of social or political consensus. Conclusion: CEE health systems had come to practice implicit rationing in the form of under-the-table payments from patients, quasi-formal payments to providers to compensate for lack of funding, and long waiting lists forcing patients to the private sector. All these difficulties pose a challenge to the implementation of integrated care.
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Semik S, Zimmermann L. Determinants of substantial public debt reductions in Central and Eastern European Countries. Empirica (Dordr) 2021; 49:53-70. [PMID: 35506057 PMCID: PMC8606627 DOI: 10.1007/s10663-021-09529-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/29/2021] [Indexed: 06/14/2023]
Abstract
Government debt development is a timeless issue in economics that has gained even more attention in light of the global financial crisis and the Covid 19 pandemic crisis. The following paper uses several specifications of a logistic probability model to examine the key determinants underlying substantial public debt reductions in Central and Eastern European EU Member States for the period 1996-2020. The results suggest that fiscal adjustments are more likely to be successful in reducing public debt if they are based on expenditure cuts rather than revenue increases. In this context, cuts in social benefits and government employee compensation prove to be particularly effective. In addition, favourable economic growth rates increase the probability of a substantial reduction in government debt.
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Affiliation(s)
- Sofia Semik
- Goethe University, 60323 Frankfurt am Main, Germany
| | - Lilli Zimmermann
- Deutsche Bundesbank, University of Applied Sciences, Schloss, 57627 Hachenburg, Germany
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Kiss D, Pados E, Kovács A, Mádi P, Dervalics D, Bittermann É, Schmelowszky Á, Rácz J. "This is not life, this is just vegetation"-Lived experiences of long-term care in Europe's largest psychiatric home: An interpretative phenomenological analysis. Perspect Psychiatr Care 2021; 57:1981-1990. [PMID: 33811648 DOI: 10.1111/ppc.12777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 03/06/2021] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Understanding the experiences of long-term care (LTC) may help to improve care by assisting mental health professionals and allowing mental health policies to be customized more effectively. DESIGN AND METHODS: Semistructured interviews were analyzed using interpretative phenomenological analysis (IPA). FINDINGS Three main themes emerged as a result: 1. Perception of selves, 2. Experience and representation of the institution, 3. Maintenance of safe spaces. PRACTICE IMPLICATIONS: Communication with patients, investigation of their identity processes, and relationship toward their past and present self during LTC might aid in well-being and sense of congruency in their identities. Nurses should encourage patients to keep connected with their memories and past selves through different activities.
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Affiliation(s)
- Dániel Kiss
- Doctoral School of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary.,Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Eszter Pados
- Doctoral School of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary.,Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Asztrik Kovács
- Doctoral School of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary.,Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Péter Mádi
- Hungarian Rapid Response Police Unit, Budapest, Hungary
| | - Dóra Dervalics
- Kilátó Piarist Career Guidance and Labor Market Development Center, Budapest, Hungary
| | | | | | - József Rácz
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary.,Department of Addictology, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary
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Takacs Haynes K, Rašković M(M. Living with Corruption in Central and Eastern Europe: Social Identity and the Role of Moral Disengagement. J Bus Ethics 2021; 174:825-845. [PMID: 34511671 PMCID: PMC8418456 DOI: 10.1007/s10551-021-04927-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 08/20/2021] [Indexed: 06/13/2023]
Abstract
UNLABELLED We examine corruption across three Central and Eastern Europe (CEE) countries (Hungary, North Macedonia and Slovenia) through a social psychology framework which integrates social identity theory, social cognitive theory and moral disengagement mechanisms. We illustrate how various social identities influence individual and collective action in terms of ethical behavior and corruption, thereby creating, maintaining and perpetuating petty, grand and systemic public/private corruption through triadic co-determination via cognition, behavior and the environment. Despite growing research on corruption normalization, less is known about the cognitive and behavioral mechanisms in ethical decision making, the cognitive workings of how individuals reconcile unethical behavior and the social psychological processes behind corruption in society and organizations. Expert interviews reveal internally conflicted multi-layered social identities perpetuating corruption, some embedded in nationalistic history and others tied to the European Union, which supports the divergent paths of CEE countries since the fall of communism. Some moral disengagement mechanisms are common across all three countries, while others are linked to specific circumstances. Social identity mechanisms feed into moral disengagement, which individuals draw upon to reconcile the conflict between unethical behavior and moral codes. Patterns of moral disengagement aggregate to the country level and explain normalization of corruption in CEE society and organizations. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s10551-021-04927-9.
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Affiliation(s)
- Katalin Takacs Haynes
- Department of Business Administration, Lerner College of Business and Economics, University of Delaware, 210 Lerner Hall, Newark, DE 19716 USA
| | - Matevž (Matt) Rašković
- School of Marketing and International Business, Victoria University of Wellington, 23 Lambton Quay, Rutherford House, Level 11, 1115, 6011 Wellington, New Zealand
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Skopec B, Sninska Z, Tzvetkov N, Ivanushkin V, Björklöf K, Hippenmeyer J, Mihaylov G. Effectiveness and safety of romiplostim among patients with newly diagnosed, persistent and chronic ITP in routine clinical practice in central and Eastern Europe: an analysis of the PLATON study. ACTA ACUST UNITED AC 2021; 26:497-502. [PMID: 34238136 DOI: 10.1080/16078454.2021.1948209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES The objective of this analysis was to assess the effectiveness and safety of romiplostim in the real-world by duration of primary immune thrombocytopenia (ITP): <3 ('newly diagnosed'), 3-12 ('persistent'), and >12 ('chronic') months. METHODS This was a post-hoc analysis of the PLATON single-arm, observational cohort study of adults from five Central and Eastern European countries receiving ≥1 romiplostim dose as second-line therapy, or where surgery was contraindicated. Durable (≥75% of measurements with ≥50 × 109 platelets/L during weeks 14-24) and overall platelet response (≥30 or ≥50 × 109 platelets/L at least once), rescue therapy, bleeding, discontinuation of other ITP medications, and adverse drug reactions (ADRs) were assessed. RESULTS Of 100 participants, 22.0% had newly diagnosed, 17.0% had persistent, and 61.0% had chronic ITP. Prior splenectomy was most frequently reported in chronic ITP (32.8%), prior bleeding was predominant in newly diagnosed patients (68.2%). Durable platelet response was achieved in 50.0% (95% confidence interval [CI]: 28.2-71.8%) of newly diagnosed, 35.3% (95% CI: 14.2-61.7%) of persistent, and 31.1% (95% CI: 19.9-44.3%) of chronic ITP patients. Overall platelet response was achieved in >80% across all strata. Safety was comparable across groups, with a low incidence of thrombotic ADRs and no bone marrow ADRs. DISCUSSION In this real-world study, platelet response to romiplostim was consistent across all strata of ITP duration. ADRs were infrequent and similar across ITP settings. CONCLUSION These findings support the utilization of romiplostim in patients with newly diagnosed and persistent ITP in accordance with recent guidelines and the recent romiplostim label extension.
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Affiliation(s)
- Barbara Skopec
- Department of Hematology, University Medical Center Ljubljana, Ljubljana, Slovenia.,Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Zuzana Sninska
- Department of Hematology and Blood Transfusion, University Hospital St. Cyril and Metod, Bratislava, Slovakia
| | - Nikolai Tzvetkov
- Clinic of Hematology, University Multiprofile Hospital for Active Treatment "Dr. Georgi Stranski" EAD, Pleven, Bulgaria
| | | | - Katja Björklöf
- Medical Affairs, Amgen (Europe North East), Rotkreuz, Switzerland
| | | | - Georgi Mihaylov
- Clinic of Hematology, Specialized Hospital for Active Treatment of Hematology Diseases AD, Sofia, Bulgaria
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30
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Matijevic P. Searching for the plot: narrative self-making and urban agriculture during the economic crisis in Slovenia. Agric Human Values 2021; 39:301-314. [PMID: 34334942 PMCID: PMC8302963 DOI: 10.1007/s10460-021-10248-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/09/2021] [Indexed: 06/13/2023]
Abstract
Analyses of household urban agriculture have demonstrated a wealth of personal, economic, social, moral or political uses for self-provisioned food, yet have often understood the practice itself as merely a production process. This 'means-to-an-end' perspective is especially pronounced in studies of locations undergoing economic hardship. Urban gardening in postsocialist Central and Eastern Europe and the former Soviet Union has been framed as an element of an informal economy, enabling household savings, access to informal networks and avoidance of industrial goods deemed ethically dubious. In this article, I present evidence from participant observation and interviews with urban gardeners conducted in 2014-2015 in Ljubljana, Slovenia, where urban agriculture proliferated during the European debt crisis that began in 2009. I interpret the material through an ecological perspective that focuses on labour in nature and highlights the interconnected, situated role of the gardener. My analysis of gardening styles, behaviours, attitudes and life-narratives of long-term urban growers challenges the utilitarian interpretation by arguing that urban agriculture in Ljubljana is in fact a means in itself-not an informal economy, but a narrative practice. While undertaken to ameliorate the effects of economic hardship, household urban agriculture first and foremost promotes individual wellbeing and restores a stable sense of self. I outline a series of self-making benefits of working with cultivated, edible nature that helped gardeners reconstruct their biographies after their previously established self-making processes collapsed in the economic downturn.
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Borbély-Pecze TB, Hloušková L, Šprlák T. Career/lifelong guidance systems and services: continuous transformations in a transition region: The case of three Central and Eastern European Countries. Int J Educ Vocat Guid 2021; 22:67-91. [PMID: 33821176 PMCID: PMC8011773 DOI: 10.1007/s10775-021-09473-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 03/12/2021] [Indexed: 06/12/2023]
Abstract
UNLABELLED This comparative study traces the foundation and development of vocational and career guidance services in three Central and Eastern European countries in the light of the contextually bound factors of this region. Since the beginning of the 20th century, political transitions and changes in the ruling structures in these countries were so frequent that the same generation was often confronted with multiple forms of governance: the rule of 'König und Kaiser', the monarchy, the communist regime, neoliberal economic policies with mass privatisation, membership of the European Union. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s10775-021-09473-4.
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Affiliation(s)
| | - L. Hloušková
- Department of Educational Sciences, Faculty of Arts, Masaryk University, Brno, Czechia
| | - T. Šprlák
- CCI Meurthe et Moselle, Nancy, France
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Janoušková M, Formánek T, Bražinová A, Mílek P, Alexová A, Winkler P, Motlová LB. Attitudes towards People with Mental Illness and Low Interest in Psychiatry among Medical Students in Central and Eastern Europe. Psychiatr Q 2021; 92:407-18. [PMID: 32780288 DOI: 10.1007/s11126-020-09817-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This study aimed to examine attitudes towards people with mental illness and psychiatry and interest in career choice in psychiatry among medical students from three medical schools in Czechia and Slovakia. A total of 495 medical students participated in a cross-sectional study. Participants completed (1) the Medical students' version of mental illness: clinicians' attitudes (MICA-2) scale, (2) the Reported and intended behaviour scale (RIBS), (3) the Attractiveness of working on a psychiatry-related position scale (P-ATTRACT), and (4) the Status of psychiatry scale (P-STATUS). Descriptive statistics, group comparisons and regression models were calculated. From 23 to 30% of students considered a specialization in psychiatry. However, only about 1% of them had a strong interest in psychiatry as a future career, moreover, students of higher years of study found psychiatry less attractive compared to those who are in the beginning of the study. The consideration of specialization in psychiatry was found to be statistically significantly associated with less stigmatizing attitudes and lower social distance towards people with mental illness. There were statistically significant differences in stigmatizing attitudes among medical schools, with a medical school emphasizing the education in psychiatry the most showing more positive attitudes. It is necessary to increase the interest in psychiatry and minimize stigma among medical students. Psychiatry curriculum in Central and Eastern European region should include more psychiatry-related courses, training in community and out-patient facilities, peer-lectors, and offer counselling after exposure to emotionally challenging clinical situations.
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Brada JC, Gajewski P, Kutan AM. Economic resiliency and recovery, lessons from the financial crisis for the COVID-19 pandemic: A regional perspective from Central and Eastern Europe. Int Rev Financ Anal 2021; 74:101658. [PMID: 36567807 PMCID: PMC9759986 DOI: 10.1016/j.irfa.2021.101658] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 11/24/2020] [Accepted: 12/30/2020] [Indexed: 05/20/2023]
Abstract
In this paper we examine resiliency, the ability to absorb and recover from economic shocks, in 199 Nuts-3 regions in Central and Eastern Europe (CEE) following the 2008 global financial crisis. We find evidence of strong positive regional spillovers, meaning that regions tend to form clusters of high-performing and low-performing areas, a process that exacerbates regional income disparities. Using the experience of the recovery from the 2008 financial crisis, we simulate the effects of the COVID-19 pandemic on the ability of these, and, by extension, other upper-middle-income countries to recover from a shock to employment caused by the incidence of COVID-19. Using our recoverability equation estimates, we find that employment in no more than 31 of the 199 regions will have fully recovered in 2 years after the onset of the recovery from the crisis. Policy implications of the findings are discussed.
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Affiliation(s)
- Josef C Brada
- Arizona State University, United States
- CERGE- Economic Institute of the Czech Academy of Sciences and Charles University, Czechia
| | - Paweł Gajewski
- Faculty of Economics and Sociology, University of Łódź, Poland
| | - Ali M Kutan
- Southern Illinois University, Edwardsville, United States
- The Society for the Study of Emerging Markets, United States
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34
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Sokol T. The Effect of EU Integration on Health Care in Central and Eastern Europe. J Health Polit Policy Law 2021; 46:147-175. [PMID: 33085963 DOI: 10.1215/03616878-8706651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The effect of EU policy and its legal framework on health care in CEE member states has been complex. In relation to health care access and financial sustainability, it has been detrimental in certain parts of CEE. This has primarily been the result of economic/fiscal governance instruments of the EU and free-movement rules facilitating outflows of health care professionals. Although there has been a general improvement in access to health care since accession to the EU, the instruments the EU has used to handle the economic crisis have somewhat offset this improvement. Additionally, outflow of health care professionals has resulted in retention strategies such as salary increases and investments in medical infrastructure in some CEE member states, increasing the standard of health care. Still, differences between East and West in terms of important health indicators continue to exist, and EU instruments aimed at compensating this generally lack power to provide meaningful solutions. It seems more solidarity between member states is the only way to increase legitimacy of the European integration in CEE member states and thus prevent them from feeling as outsiders within the EU. Without such a development, CEE countries will continue to lag behind other parts of the Union.
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Boyko A, Therapontos C, Horakova D, Szilasiová J, Kalniņa J, Kolontareva J, Gross-Paju K, Selmaj K, Sereike I, Milo R, Gabelić T, Rot U. Approaches and challenges in the diagnosis and management of secondary progressive multiple sclerosis: A Central Eastern European perspective from healthcare professionals. Mult Scler Relat Disord 2021; 50:102778. [PMID: 33592384 DOI: 10.1016/j.msard.2021.102778] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 01/15/2021] [Accepted: 01/16/2021] [Indexed: 10/22/2022]
Abstract
Secondary progressive multiple sclerosis (SPMS) is a debilitating condition characterized by gradual worsening after an initial relapsing disease course. Despite the recent advances in our understanding of the disease, the diagnosis and treatment of SPMS continue to be challenging in routine clinical practice. The aim of this review article is to present the views of leading MS experts on the challenges in the diagnosis and management of SPMS and clinicians' perspectives in Central and Eastern Europe. This article also provides recommendations of MS experts to improve the situation with diagnosis and management of SPMS. Many countries within Central and Eastern Europe have high prevalence of MS (>100 per 100,000 population). Consistent with the global trend, in the absence of reliable tests or biomarkers, SPMS at early stage remains undiagnosed. Due to diagnostic uncertainty and lack of a universally accepted disease definition, clinicians rely more on retrospective analysis of the clinical symptoms to confirm the diagnosis. With the lack of awareness and poor understanding of the timing of the onset of SPMS, clinicians may tend to direct attention to relapses than the symptoms of progression, which leads to underestimation of SPMS. Although several predictors of progression to SPMS have been identified, their predictive value is highly variable. Therefore, defining the transitioning period as a separate stage of MS is essential. According to experts' opinion, frequent follow-up of patients and periodic assessment of progression are recommended for the timely identification of patients transitioning from RRMS to SPMS. MSProDiscuss Tool is an example of a quick assessment tool for identifying patients progressing from RRMS to SPMS. MS progression is usually assessed by changes in Expanded Disability Status Scale (EDSS) scores. As EDSS scores tend to fluctuate when measured in the short term (3-6 months), a longer period (≥12 months) may be needed to confirm the progression. Assessment of cognitive function is also important for evaluating secondary progression. Compartmentalization of inflammation within the central nervous system is an important reason behind the limited success of disease-modifying therapies (DMTs) for treating SPMS. Most of the DMTs fail to cross the blood-brain barrier; only 38% of the tested DMTs achieved their primary endpoint in SPMS. In Europe, siponimod is the first oral treatment for adults with active SPMS. Particularly, in Central and Eastern Europe, patients with SPMS are still being prescribed less efficacious DMTs and interferons. The absence of alternative treatments in SPMS supports the use of new products (siponimod and others); however the decision to initiate siponimod therapy in more severe patients (EDSS score of 7 or higher) should be individualized in consultation with the payers. The focus should be on early treatment initiation to delay disease progression.
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Affiliation(s)
- Alexey Boyko
- Department of Neurology, Neurosurgery and Medical Genetics, Pirogov's Russian National Research Medical University, Moscow, Russian Federation; Department of Neuropharmacology, Federal Center of Brain and Neurotechnology, Moscow, Russian Federation.
| | | | - Dana Horakova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine Charles University and General University Hospital in Prague, Czech Republic
| | - Jarmila Szilasiová
- Department of Neurology, Faculty of Medicine, P. J. Safarik University, Kosice, Slovakia
| | - Jolanta Kalniņa
- Centre of Multiple Sclerosis, Latvian Maritime Medicine Centre, Rīga, Latvija
| | | | - Katrin Gross-Paju
- West-Tallinn Central Hospital Centre for Neurological Diseases, Tallinn, Estonia; TalTech, Tallinn, Estonia
| | - Krzysztof Selmaj
- Center for Neurology, Lodz, Poland; Collegium Medicum, Department of Neurology, University of Warmia and Mazury, Olsztyn, Poland
| | - Ieva Sereike
- Centre of Neurology, Vilnius University, Vilnius, Lithuania
| | - Ron Milo
- Department of Neurology, Barzilai Medical Center, Ashkelon, Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel
| | - Tereza Gabelić
- Department of Neurology, Referral Center for Autonomic Nervous System Disorders, University Hospital Center Zagreb, Zagreb, Croatia; School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Uroš Rot
- Department of Neurology University Medical Center Ljubljana, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Bitter I, Mohr P, Raspopova N, Szulc A, Samochowiec J, Micluia IV, Skugarevsky O, Herold R, Mihaljevic-Peles A, Okribelashvili N, Dragašek J, Adomaitiene V, Rancans E, Chihai J, Maruta N, Marić NP, Milanova V, Tavčar R, Mosolov S. Assessment and Treatment of Negative Symptoms in Schizophrenia-A Regional Perspective. Front Psychiatry 2021; 12:820801. [PMID: 35185643 PMCID: PMC8855151 DOI: 10.3389/fpsyt.2021.820801] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 12/17/2021] [Indexed: 11/13/2022] Open
Abstract
Clinicians and researchers consider that there are a variety of symptoms that constitute negative symptoms in schizophrenia, and they may use different definitions for the same symptoms. These differences are also reflected in a variety of negative symptom rating scales. Both research and clinical work are negatively affected by the lack of consensus regarding the symptoms that constitute negative symptoms in schizophrenia. Leading research groups have investigated ways to reduce heterogeneity in the domain of negative symptoms in schizophrenia; however, little attention has been paid to regional differences in the concepts of negative symptoms in schizophrenia. The objective of this review was to collect and summarize information about the assessment and treatment of negative symptoms of schizophrenia in Central and Eastern Europe (CEE). Nineteen experts from 17 countries in CEE participated in this project. The participants collected information about their countries, including the following: (1) the most important publications about negative symptoms in schizophrenia (irrespective of the time of their publication); (2) the most frequently used negative symptom of schizophrenia in clinical practice; (3) definitions of frequently used negative symptoms; and (4) treatment of negative symptoms in schizophrenia. The participating experts/countries most frequently reported the following five negative symptoms: avolition, blunted affect, alogia, asociality, and anhedonia. Several experts also considered other symptoms as belonging to the negative symptom domain, such as a decrease in energy level and changes in personality. The importance of evaluating the long-term course and the relationship between negative symptoms and other symptom domains was also noted. No noticeable differences were reported in the treatment of negative symptoms compared to currently published guidelines and algorithms. The most frequently reported negative symptoms included those defined by the NIMH-MATRICS consensus statement on negative symptoms and recently endorsed in a guidance paper of the European Psychiatric Association. The main differences in the concepts, names, and definitions of primary negative symptoms, especially those related to personality changes, and to the evaluation of the long-term course and relationship between different symptom domains in CEE compared to the current English language literature deserve the attention of psychiatrists and other professionals in this field.
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Affiliation(s)
- Istvan Bitter
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Pavel Mohr
- Clinical Center, National Institute of Mental Health, Klecany, Czechia.,Third Faculty of Medicine, Charles University in Prague, Prague, Czechia
| | - Natalia Raspopova
- Department of Psychiatry, Narcology and Neurology of Kazakh-Russian Medical University, Almaty, Kazakhstan
| | - Agata Szulc
- Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland
| | - Jerzy Samochowiec
- Department of Psychiatry, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Ioana Valentina Micluia
- Discipline of Psychiatry, Department of Neurosciences, University of Medicine and Pharmacy, Iuliu Haieganu, Cluj-Napoca, Romania
| | - Oleg Skugarevsky
- Department of Psychiatry & Medical Psychology, Belarusian State Medical University, Minsk, Belarus
| | - Róbert Herold
- Department of Psychiatry and Psychotherapy, Medical School, University of Pécs, Pécs, Hungary
| | - Alma Mihaljevic-Peles
- Clinical Hospital Centre Zagreb and School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Nino Okribelashvili
- Department of Psychiatry and Medical Psychology, Tbilisi State University, Tbilisi, Georgia
| | - Jozef Dragašek
- First Department of Psychiatry, University of P. J. Safarik, Medical Faculty and University Hospital of L. Pasteur, Kosice, Slovakia
| | - Virginija Adomaitiene
- Department of Psychiatry, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Elmars Rancans
- Department of Psychiatry and Narcology, Riga Stradins University, Riga, Latvia
| | - Jana Chihai
- Medical Psychology and Narcology Department, State Medical and Pharmaceutical University Nicolae Testemitanu, Chisinau, Moldova
| | - Natalia Maruta
- Department of Borderline Psychiatry, Institute of Neurology, Psychiatry and Narcology of the National Academy of Medical Science of Ukraine, Kharkiv, Ukraine
| | - Nadja P Marić
- Faculty of Medicine University of Belgrade & Institute of Mental Health, Belgrade, Serbia
| | - Vihra Milanova
- Psychiatric Clinic, University Hospital "Alexandrovska", Sofia, Bulgaria
| | - Rok Tavčar
- University Psychiatric Clinic Ljubljana and School of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Sergey Mosolov
- Department for Therapy of Mental Disorders, Moscow Research Institute of Psychiatry, Moscow, Russia.,Department of Psychiatry, Russian Medical Academy of Continuous Professional Education, Moscow, Russia
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Doblytė S. Shame in a post-socialist society: a qualitative study of healthcare seeking and utilisation in common mental disorders. Sociol Health Illn 2020; 42:1858-1872. [PMID: 32780502 DOI: 10.1111/1467-9566.13170] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 07/07/2020] [Accepted: 07/14/2020] [Indexed: 06/11/2023]
Abstract
After the regime collapse, the former socialist societies in Central and Eastern Europe experienced rapid social and economic transformations. Consequently, mental health deterioration coupled with ambitions to break with the past triggered reforms of mental health systems. Yet, 30 years later, mental health in the region remains poor. Stigma of mental illness may be one of the factors that delays help seeking and, therefore, maintains status quo. Thus, the aim of the article is to better understand the roots of stigma and the process of stigmatisation in one of these countries - Lithuania. Drawing on Norbert Elias's model of established-outsider relations, the article presents the analysis of 23 in-depth interviews with healthcare providers and users of services diagnosed with depression or anxiety disorders. Said analysis reveals how stigma of mental illness might result in damaged self-image and shame of feeling different. Mental illness and healthcare seeking are perceived as a threat to culturally and historically determined self-values, at the core of which seems to be intolerance of difference. The article contributes not only to research concerning mental health in a relatively understudied region of Central and Eastern Europe, but also to existing literature on stigma as embedded in a local context.
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Tombat K, van Dijk JP. Roma Health: An Overview of Communicable Diseases in Eastern and Central Europe. Int J Environ Res Public Health 2020; 17:ijerph17207632. [PMID: 33092048 PMCID: PMC7588998 DOI: 10.3390/ijerph17207632] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 10/15/2020] [Accepted: 10/16/2020] [Indexed: 11/22/2022]
Abstract
The Roma are Europe’s largest minority. They are also one of its most disadvantaged, with low levels of education and health and high levels of poverty. Research on Roma health often reveals higher burdens of disease in the communities studied. This paper aims to review the literature on communicable diseases among Roma across Eastern and Central Europe. A PubMed search was carried out for communicable diseases among Roma in these parts of Europe, specifically in Romania, Bulgaria, Hungary, Serbia, Slovakia, the Czech Republic and North Macedonia. The papers were then screened for relevance and utility. Nineteen papers were selected for review; most of them from Slovakia. Roma continue to have a higher prevalence of communicable diseases and are at higher risk of infection than the majority populations of the countries they live in. Roma children in particular have a particularly high prevalence of parasitic disease. However, these differences in disease prevalence are not present across all diseases and all populations. For example, when Roma are compared to non-Roma living in close proximity to them, these differences are often no longer significant.
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Affiliation(s)
- Kabir Tombat
- Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Ant. Deusinglaan 1, 9713 AV Groningen, The Netherlands;
- Correspondence:
| | - Jitse P. van Dijk
- Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Ant. Deusinglaan 1, 9713 AV Groningen, The Netherlands;
- Graduate School Kosice Institute for Society and Health, Medical Faculty, P.J. Safarik University, Tr. SNP 1, 040 01 Kosice, Slovakia
- Olomouc University Society and Health Institute, Palacky University, 771 11 Olomouc, Czech Republic
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Malinowski KP, Kawalec P, Trąbka W, Sowada C, Petrova G, Manova M, Savova A, Draganić P, Slabý J, Männik A, Márky K, Rugaja Z, Gulbinovic J, Tesar T, Paveliu MS. Health technology assessment and reimbursement policy for oncology orphan drugs in Central and Eastern Europe. Orphanet J Rare Dis 2020; 15:277. [PMID: 33032634 DOI: 10.1186/s13023-020-01556-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 09/23/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The reimbursement of orphan drugs (OD) is an increasingly important for country policymakers, and still insufficiently understood, especially in Central and Eastern Europe. The aim of this research was to provide a comprehensive description of country-specific health technology assessment (HTA) policies as well as evaluate the percentage of HTA recommendations and reimbursement decisions for oncology OD. In addition, the study was designed to elucidate the impact of reimbursement of these drugs on the public budget and the agreement between HTA recommendations and reimbursement decisions in the analysed countries. A questionnaire survey was used to collect data on the reimbursement status, HTA recommendation, marketing authorisation, and public expenses on reimbursement in 2014, 2015, and 2016 for all oncology drugs with an orphan designation by the European Medicine Agency in 2017 in Bulgaria, Croatia, Czechia, Estonia, Hungary, Latvia, Lithuania, Poland, Romania, and Slovakia. The agreement between the HTA recommendation and reimbursement status was assessed using the kappa coefficient. The Pearson's correlation was used to analyse the relationship between gross domestic product (GDP) and GDP per capita and reimbursement expenses. RESULTS A total of 36 drugs were analysed (25% conditionally approved; 5.56% approved under exceptional circumstances). The share of reimbursed drugs ranged from 11.11% in Latvia to 41.67% in Poland. The highest share of positive recommendations was observed for Bulgaria and Estonia (36.11%), and the lowest, for Latvia (11.11%). The agreement varied from 0.4 for Poland to 1 for Latvia, Hungary, and Slovakia. Expenses were correlated with GDP (0.95 [0.81-0.99]), and not with GDP per capita (0.54 [- 0.136 to 0.873]). Expenses per capita were not correlated with GDP per capita (0.52 [- 0.15 to 0.87]). CONCLUSIONS In Hungary, Latvia, and Slovakia, a positive recommendation was associated with a reimbursement, and a negative one, with the lack of reimbursement. The reimbursement of oncology OD is associated with a growing burden for public budget, and the expenses are correlated with the total GDP. The highest share of drugs with any recommendation was observed in Poland, and the lowest, in Latvia and Romania. The share of reimbursed drugs was the lowest in Latvia and the highest in Poland.
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Németh B, Goettsch W, Kristensen FB, Piniazhko O, Huić M, Tesař T, Atanasijevic D, Lipska I, Kaló Z. The transferability of health technology assessment: the European perspective with focus on central and Eastern European countries. Expert Rev Pharmacoecon Outcomes Res 2020; 20:321-330. [PMID: 32500749 DOI: 10.1080/14737167.2020.1779061] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Lower-income European countries have a worse health status and less funds for health care compared to Western Europe. Despite their limited human and financial capacities for conducting Health Technology Assessment (HTA), the need for evidence-based decision-making is growing. Two main approaches emerged as potential solutions: joint clinical assessments on the European level, and simplified procedures relying on the judgments of well-established HTA agencies of Western countries. AREAS COVERED Based on considerations of transferability, the European Network for Health Technology Assessment (EUnetHTA) was built up to harmonize HTA methodologies across the European Union, and to develop an HTA Core Model by focusing on joint production of relative effectiveness assessment, which can be used as a basis for national value assessments. The second approach has been suggested in various forms without considering transferability issues. EXPERT OPINION Joint clinical assessments reduce duplication of efforts based on appropriate scientific rationale. On the other hand, recent examples show that relying on judgments of HTA agencies from wealthier countries with potentially different health-care priorities can lead to suboptimal allocation decisions. In the short term, some stakeholders may benefit from ignoring transferability, but it will ultimately lead to limited access in other disease areas.
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Affiliation(s)
| | - Wim Goettsch
- WHO CollaboratingUtrecht Centre for Pharmaceutical Policy, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University , Utrecht, The Netherlands.,National Health Care Institute , Diemen, The Netherlands
| | - Finn Børlum Kristensen
- Faculty of Health Sciences, Department of Public Health, Research Unit of User Perspectives, University of Southern Denmark , Odense, Denmark.,Department of Strategy and Innovation, Copenhagen Business School , Copenhagen, Denmark
| | - Oresta Piniazhko
- Health Technology Assessment Department, State Expert Centre of Ministry of Health of Ukraine , Kyiv, Ukraine
| | | | - Tomáš Tesař
- Department of Organisation and Management in Pharmacy, Faculty of Pharmacy, Comenius University , Bratislava, Slovakia
| | | | - Iga Lipska
- Departament of Health Care Services, National Health Fund HQ , Warsaw, Poland
| | - Zoltán Kaló
- Syreon Research Institute , Budapest, Hungary.,Centre for Health Technology Assessment, Semmelweis University , Budapest, Hungary
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Myslinska DR. Not Quite Right: Representations of Eastern Europeans in ECJ Discourse. Int J Polit Cult Soc 2020; 34:271-307. [PMID: 32836767 PMCID: PMC7283037 DOI: 10.1007/s10767-020-09368-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Although the increasing responsiveness of the Court of Justice of the European Union (the 'ECJ') jurisprudence to western Member States' concerns regarding Central and Eastern European ('CEE') nationals' mobility has garnered academic attention, ECJ discourse has not been scrutinised for how it approaches the CEE region or CEE movers. Applying postcolonial theory, this article seeks to fill this gap and to explore whether there are any indications that ECJ discourse is in line with the historical western-centric inferiorisation of the CEE region. A critical discourse analysis of a set of ECJ judgments and corresponding Advocate General opinions pertaining to CEE nationals illustrates not only how the ECJ adopts numerous discursive strategies to maintain its authority, but also how it tends to prioritise values of the western Member States, while overlooking interests of CEE movers. Its one-sided approach is further reinforced by referring to irrelevant facts and negative assumptions to create an image of CEE nationals as socially and economically inferior to westerners, as not belonging to the proper EU polity and as not quite deserving of EU law's protections. By silencing CEE nationals' voices, while disregarding the background of east/west socio-economic and political power differentials and precariousness experienced by many CEE workers in the west, such racialising discourse normalises ethnicity- and class-based stereotypes. These findings also help to contextualise both EU and western policies targeting CEE movers and evidence of their unequal outcomes in the west, and are in line with today's nuanced expressions of racisms. By illustrating the ECJ's role in addressing values pertinent to mobile CEE individuals, this study facilitates a fuller appreciation of the ECJ's power in shaping and reflecting western-centric EU identity and policies. Engaging with such issues will not only allow us to better appreciate-and question-the ECJ's legitimacy, but might also facilitate a better understanding of power dynamics within the EU. This study also makes significant theoretical and methodological contributions. It expands (and complicates) the application of postcolonial theory to contemporary intra-EU processes, while illustrating the usefulness of applying critical discourse analysis to exploring differentiation, exclusion, subordination and power within legal language.
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Abstract
During their transition, Central and Eastern European countries’ health and social care systems have undergone significant changes, and are currently dealing with serious problems of disintegration, coordination, and a lack of control over the market environment, especially for meeting patients’ needs. The increased health and social needs related to the ageing society and epidemiological patterns in these countries also require increased funding, reformation of rationing, sectors to be integrated (the managed care approach), and the development of an analytical information base for surveillance of new health and social care solutions.
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Abstract
The paper examines the relation between religiosity and cognitive appraisal of the subjective well-being of the Central and Eastern European's elderly population. The first part of the paper is dedicated to examining of the scientific literature. In the second part, the authors explore the data basis corresponding to the 6th wave of World Value Survey. The authors use the heterogeneous correlation and the multi-linear regression analysis in order to explain the relation between religiosity and subjective well-being of the old aged. Our results suggest that in the case of the Central Eastern European elderly satisfaction with life is mostly influenced by health and income. It is likely that for Central and Eastern European's elders religious practices do not sufficiently influence their life satisfaction.
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Affiliation(s)
- Simona Ioana Bodogai
- Department of Sociology and Social Work, University of Oradea, University Street, No. 1, 410087, Oradea, BH, Romania.
| | - Şerban Olah
- Department of Sociology and Social Work, University of Oradea, University Street, No. 1, 410087, Oradea, BH, Romania
| | - Gabriel Roşeanu
- Department of Psychology, University of Oradea, University Street, No. 1, 410087, Oradea, Romania
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Gokengin D, Aho I, Sarıgül Yıldırım F, Bukovinova P, Siwak E, Papadopoulos A, Sedlacek D, Kowalska J. Exposure to dolutegravir in pregnant women living with HIV in Central and Eastern Europe and neighboring countries - data from the ECEE Network Group. Ginekol Pol 2020; 90:411-415. [PMID: 31392711 DOI: 10.5603/gp.2019.0070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 07/03/2019] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES The purpose of this study was to investigate dolutegravir (DTG) use among women and exposure to DTG during pregnancy in real world in Central and Eastern Europe and neighboring countries. MATERIAL AND METHODS Centres from 20 countries included in the Euroguidelines in Central and Eastern Europe (ECEE) Network and Finland were asked to complete an on-line questionnaire. RESULTS Seven centres from Czech Republic, Finland, Greece, Poland, Slovakia, and Turkey provided detailed information. DTG exposure was reported in 415 women, of which 26 were during pregnancy. Of those, 22 were on DTG at the time of conception and 4 had started DTG during pregnancy. Few women had conventional risk factors. The data on folic acid usage was unknown for eight women; 14 were using and four were not using folic acid. Four pregnancies were ongoing at the time of the study and of those with an outcome, 77.3% resulted with term, 13.6% preterm delivery, 4.5% spontaneous and 4.5% medical abortion. CONCLUSIONS The DTG signal report indicates the importance of safety research for drug use in pregnancy and highlights the urgent need for systematic surveillance of pregnancy outcomes and neonatal surveillance. Countries with low- or moderate HIV prevalence should be included in studies reviewing pregnancy outcomes and in any surveillance system to ensure the accuracy of drug safety revision.
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Affiliation(s)
- Deniz Gokengin
- Ege University Faculty of Medicine Department of Infectious Diseases, Izmir, Turkey.
| | - Inka Aho
- Helsinki University Hospital, Helsinki, Finland
| | | | - Pavla Bukovinova
- Department of Infectious Diseases and Geographical Medicine UH, Bratislava, Slovakia
| | - Ewa Siwak
- Hospital for Infectious Diseases, HIV Out-Patient Clinic, Warsaw, Poland
| | | | - Dalibor Sedlacek
- HIV Centre, Department of Infectious Diseases, University Hospital, Plzen, Czech Republic
| | - Justyna Kowalska
- Hospital for Infectious Diseases, HIV Out-Patient Clinic, Warsaw, Poland.,Medical University of Warsaw, Department of Adult's Infectious Diseases, Warsaw, Poland
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Abstract
Expenditures on mental health care in the Czech Republic are not being published regularly, yet they are indispensable for evaluation of the ongoing reform of Czech mental health care. The main objective of this study is to estimate the size of these expenditures in 2015 and make a comparison with the last available figures from the year 2006. The estimation is based on an OECD methodology of health accounts, which structures health care expenditures according to health care functions, provider industries, and payers. The expenditures are further decomposed according to diagnoses, and inputs used in service production. The amount spent on mental health care in 2015 reached more than 13.7 billion Czech korunas (EUR 501.6 million), which represented 4.08% of the total health care expenditures. This ratio is almost identical with the 2006 share (4.14%). There are no significant changes in the relative expenditures on mental health care and in the structure of service provision. The Czech mental health care system remains largely hospital based with most of all mental health care expenditures being spent on inpatient care. Future developments in the expenditures will indicate the success of the current effort to deinstitutionalise mental health care.
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Affiliation(s)
- Hana M Broulikova
- Department of Public Mental Health, National Institute of Mental Health, Topolová 748, 250 67 Klecany, Prague, Czech Republic.
- Faculty of Informatics and Statistics, University of Economics, Prague, Czech Republic.
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, De Boelelaan 1105, 1081 HV, Amsterdam, the Netherlands.
| | - Martin Dlouhy
- Faculty of Informatics and Statistics, University of Economics, Prague, Czech Republic
| | - Petr Winkler
- Department of Public Mental Health, National Institute of Mental Health, Topolová 748, 250 67 Klecany, Prague, Czech Republic
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Frasch JJ, Petrea I, Chihai J, Smit F, Oud M, Shields-Zeeman L. Taking steps towards deinstitutionalizing mental health care within a low and middle-income country: A cross-sectional study of service user needs in the Republic of Moldova. Int J Soc Psychiatry 2020; 66:49-57. [PMID: 31603368 PMCID: PMC6963171 DOI: 10.1177/0020764019879951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
AIM The current research was conducted in the context of an ongoing reform of mental health services in the Republic of Moldova since 2014, where efforts have been devoted to creating community-based mental health services. This article presents a snapshot of the needs of mental health service users in the Republic of Moldova and helps to understand how and with which services their needs can be addressed. METHODS This cross-sectional study compared the levels of needs (CANSAS scale), quality of life (EQ-5D 3L), mental health status (MINI for psychotic disorders) and functioning (WHO-DAS) among mental health service users in the psychiatric hospital in Chisinau, Moldova. All service users resided in districts where community mental health services were being developed. Correlations between quality of life, functioning and unmet need were explored. RESULTS Of 83 participants, one third had a psychotic or a mood disorder. On average, participants reported needs in 9.41 domains (SD = 4.41), of which 4.29 were unmet (SD = 3.63). Most unmet needs related to intimacy and relation to others. The level of functioning and quality of life were reported. We found strong, negative associations between the number of unmet needs and level of functioning, as well as the quality of life. We also found that higher functioning levels were positively associated with higher quality of life. CONCLUSION There were a high number of unmet needs among this inpatient population, particularly social needs and service-related needs. A continuum of inpatient and outpatient care and individual treatment plans can help address the different needs of different patients. Individual treatment plans for patients and the choice of the appropriate treatment for patients could be guided by an assessment of service users' (unmet) needs of care and level of functioning.
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Affiliation(s)
- Jona J Frasch
- Trimbos Instituut, Utrecht, The Netherlands.,Leiden University, Leiden, The Netherlands
| | | | - Jana Chihai
- Trimbos Moldova, Chișinău, The Republic of Moldova.,Department of Psychiatry, Narcology and Medical Psychology, State University of Medicine and Pharmacy 'Nicolae Testemițanu', Chișinău, The Republic of Moldova
| | - Filip Smit
- Trimbos Instituut, Utrecht, The Netherlands.,Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Fiedor D, Král O, Frajer J, Šerý M, Szczyrba Z. What do Residents Consider to be Gambling and What are Their Attitudes Towards it? Evidence from the Czech Republic. J Gambl Stud 2020; 35:1347-1360. [PMID: 30334120 DOI: 10.1007/s10899-018-9804-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The aim of the article is to contribute to an understanding of the attitudes of post-communist Europe's inhabitants towards gambling, and of their opinions concerning which activities can be regarded as gambling. The Attitudes Towards Gambling Scale (ATGS-8) questionnaire was used in the survey, ensuring the international comparability of the results. For the subsequent in-depth analysis of attitudes we mainly used multidimensional statistical methods. The survey, conducted in 2017, had 1092 respondents. The least negative attitudes to gambling were found in the younger age groups, while the attitudes of senior citizens were the most negative. Concerning participation in gambling, 68.4% of the respondents had taken part in at least one of the range of gambling activities offered as choices. Participation in gambling is an important factor influencing the overall attitude of the respondents to gambling. Of equal importance was the range of intensity in their perceptions of which games can be considered to be gambling, with four similarly perceived types of gambling identified. The research shows that gambling is perceived negatively by the population of the Czech Republic. The explanation may be found in the substantial media coverage of gambling related to changes in the legislation and the tightening of restrictions.
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Affiliation(s)
- David Fiedor
- Department of Sociology, Andragogy and Cultural Anthropology, Palacký University, Olomouc, Czech Republic.
| | - Ondřej Král
- Department of Geography, Palacký University, Olomouc, Czech Republic
| | - Jindřich Frajer
- Department of Geography, Palacký University, Olomouc, Czech Republic
| | - Miloslav Šerý
- Department of Geography, Palacký University, Olomouc, Czech Republic
| | - Zdeněk Szczyrba
- Department of Geography, Palacký University, Olomouc, Czech Republic
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Tarnoki AD, Tarnoki DL, Forgo B, Szabo H, Melicher D, Metneki J, Littvay L. The Hungarian Twin Registry Update: Turning From a Voluntary to a Population-Based Registry. Twin Res Hum Genet 2019; 22:561-6. [PMID: 31907087 DOI: 10.1017/thg.2019.100] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Since our last report on the voluntary Hungarian Twin Registry (HTR) in 2012, the number of pairs or multiplets included increased from 310 to 1044. Efforts to turn the registry into a population-based one are on the way. Nearly 128,000 twins living in Hungary (98,500 adults) will be mailed information on how to register on the new HTR website. Twins will be asked to invite their spouses and immediate family members. Meanwhile, strong cooperation through exchange programs has been developed with other foreign twin registries. Current research focuses on radiogenomics, musculoskeletal, cardiovascular and respiratory diseases, gut microbiome as well as basic molecular research and yielded new awards and further publications.
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Luna E, Ruiz M, Malyutina S, Titarenko A, Kozela M, Pająk A, Kubinova R, Bobak M. The prospective association between frequency of contact with friends and relatives and quality of life in older adults from Central and Eastern Europe. Soc Psychiatry Psychiatr Epidemiol 2020; 55:1001-1010. [PMID: 32040668 PMCID: PMC7394932 DOI: 10.1007/s00127-020-01834-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 02/03/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE Studies suggest that frequent contact with friends and relatives promote mental wellbeing in later life, but most evidence comes from Western populations. We investigated the prospective relationship between frequency of contact with friends and relatives and quality of life (QoL) among older Central and Eastern European (CEE) adults and whether depressive symptoms mediated the hypothesised longitudinal relationship. METHODS Data from 6106 participants from the Health, Alcohol and Psychosocial factors In Eastern Europe (HAPIEE) study were used. Frequency of contact with friends and relatives was measured at baseline. QoL, at baseline and follow-up, was measured by the Control, Autonomy, Self-realisation, and Pleasure (CASP) 12-item scale. After assessing the prospective association using multivariable linear regression, the mediational hypothesis was tested using path analysis. RESULTS There was a significant prospective association between frequency of contact with friends and relatives and CASP-12 score (0-36) in fully adjusted models. Per every one unit increase in frequency of contact, there was a 0.12 (95% CI 0.06, 0.17) increase in CASP-12 score at follow-up, accounting for sociodemographic, health-related and baseline QoL. Pathway results showed that 81% of the longitudinal effect of frequency of contact on QoL was mediated through depressive symptoms. CONCLUSIONS Frequent contact with friends and relatives improves QoL of older Central and Eastern European adults, partly through buffering against depressive symptoms. Interventions to improve QoL at older ages should incorporate effective management of common mental disorders such as depression.
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Affiliation(s)
- Eliazar Luna
- Research Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK.
| | - Milagros Ruiz
- Research Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK
- Faculty of Physical Education and Sport, Charles University, José Martího 31162 52, Prague, Czech Republic
| | - Sofia Malyutina
- Laboratory of Ethipathogenesis and Clinics of Internal Diseases, Institute of Internal and Preventive Medicine, 175/1, Borisa Bogatkova street, Novosibirsk, Russia
| | - Anastasiya Titarenko
- Laboratory of Ethipathogenesis and Clinics of Internal Diseases, Institute of Internal and Preventive Medicine, 175/1, Borisa Bogatkova street, Novosibirsk, Russia
| | - Magdalena Kozela
- Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Grzegórzecka 20, 31-531, Krakow, Poland
| | - Andrzej Pająk
- Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Grzegórzecka 20, 31-531, Krakow, Poland
| | - Ruzena Kubinova
- Centre for Environmental Health Monitoring, National Institute of Public Health, Srobarova 48, 10042, Prague, Czech Republic
| | - Martin Bobak
- Research Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK
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Kahancová M, Meszmann TT, Sedláková M. Precarization via Digitalization? Work Arrangements in the On-Demand Platform Economy in Hungary and Slovakia. Front Sociol 2020; 5:3. [PMID: 33869412 PMCID: PMC8022458 DOI: 10.3389/fsoc.2020.00003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 01/14/2020] [Indexed: 05/06/2023]
Abstract
The concept of precarity is increasingly used for an analysis of standard and non-standard (atypical) employment forms-yet among atypical employment forms, platform-driven work is rarely included. This paper aims to fill this gap and provide a refined analytical framework for an evaluation of precarity in employment arrangements applicable to on-demand platform work. The legitimacy of such an analytical framework is two-fold. First, it allows identifying the dimensions of precarity in on-demand platform work. Second, it extends the understanding of how a general situation in the labor market connects to work precarity in on-demand platform work. The analytical framework is applied to evidence from two countries in Central and Eastern Europe-Hungary and Slovakia, where the rise of precarious employment went hand in hand with the rise of work via digital platforms. The central claim of the paper is that precarity in on-demand platform work is especially manifest in the dimensions of autonomy at work and of interest representation. Furthermore, digitalization enforces precarity, while at the same time, it mitigates labor market segmentation between standard and non-standard workers as distinct groups of workers.
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