Strategies to address non-communicable diseases in the Commonwealth of Independent States countries: a scoping review.

AIM: The aim of this study is to review the literature in Commonwealth of Independent States (CIS) countries with regard to their response to non-communicable diseases (NCDs) and the implementation of the World Health Organization (WHO) Package of Essential Non-communicable (PEN) disease interventions for primary health care. BACKGROUND: NCDs are estimated to account from 62% to 92% of total deaths in CIS countries. Current management of NCDs in CIS countries is focused on specialists and hospital care versus primary health care (PHC) as recommended by the WHO. METHODS: This paper uses a scoping review of published and grey literature focusing on diabetes and hypertension in CIS countries. These two conditions are chosen as they represent a large burden in CIS countries and are included in the responses proposed by the WHO PEN. FINDINGS: A total of 96 documents were identified and analysed with the results presented using the WHO Health System Building Blocks. Most of the publications identified focused on the service delivery (41) and human resources (20) components, while few addressed information and research (17), and only one publication was related to medical products. As for their disease of focus, most studies focused on hypertension (14) and much less on diabetes (3). The most studies came from Russia (18), followed by Ukraine (21) and then Kazakhstan (12). Only two countries Moldova and Kyrgyzstan have piloted the WHO PEN. Overall, the studies identified highlight the importance of the PHC system to better control and manage NCDs in CIS countries. However, these present only strategies versus concrete interventions. One of the main challenges is that NCD care at PHC in CIS countries continues to be predominantly provided by specialists in addition to focusing on treatment versus preventative services.

Forecasting the carbon dioxide emissions in 53 countries and regions using a non-equigap grey model.

Non-equigap GM(1,1) model with conformable fractional accumulation (CFNGM(1,1)) is proposed to analyze the relationship between energy consumption and carbon dioxide emissions. Two cases are used to prove the validity of the model. In this article, energy consumption is used as input and carbon dioxide emissions are used as output. Carbon dioxide emissions of 53 countries and regions in North America, South America, Europe, Commonwealth of Independent States (CIS), Middle East, Africa, and Asia Pacific are predicted. The forecast results show that the carbon dioxide emissions of 30 countries and regions have risen to varying degrees. The top three countries with carbon dioxide emissions in the next three years are China, the USA, and India. More attention should be paid to the carbon dioxide emissions of China.

Implementing Health Warnings on Alcoholic Beverages: On the Leading Role of Countries of the Commonwealth of Independent States.

Despite being a psychoactive substance and having a major impact on health, alcohol has to date escaped the required labeling regulations for either psychoactive substances or food. The vast majority of the countries in the WHO European Region have stricter labeling requirements for bottled water and health warning provisions for over-the-counter medications than for alcoholic beverages. However, more progress in implementing health warnings has been made in the eastern part of the WHO European Region, largely because of the recent technical regulation put in place by the newly formed Eurasian Economic Union. The present contribution provides an overview of the existing legislation regarding the placement of alcohol health warnings on advertisements and labels on alcohol containers in the countries of the Commonwealth of Independent States (CIS; Armenia, Azerbaijan, Belarus, Kazakhstan, Kyrgyzstan, Moldova, Russia, Tajikistan, Turkmenistan, and Uzbekistan) and discusses their potential gaps and shortfalls. It also reviews the evolution of the Eurasian Economic Union Technical Regulation 047/2018, which is, to date, the only international document to impose binding provisions on alcohol labeling. The technical regulation's developmental process demonstrates how the comprehensive messages and strong requirements for health warnings that were suggested initially were watered down during the consultation process.

Differences in In Vitro Properties of Pancreatin Preparations for Pancreatic Exocrine Insufficiency as Marketed in Russia and CIS.

BACKGROUND: Pancreatic enzyme-replacement therapy (PERT), provided as pancreatin to patients with pancreatic exocrine insufficiency (PEI), is considered an essential substitute for the pivotal physiological function the pancreas fulfills in digestion. PEI involves a reduction in the synthesis and secretion of pancreatic enzymes (lipase, protease, amylase), which leads to an inadequate enzymatic response to a meal and consequently to maldigestion and malabsorption of nutrients. The efficacy of PERT is strongly dependent on enzyme activity, dissolution, and pancreatin particle size. OBJECTIVE: The physiological properties of eight pancreatin preparations (nine batches; five different brands) available in Russia and CIS (Commonwealth of Independent States: Armenia, Azerbaijan, Belarus, Kazakhstan, Kyrgyzstan, Moldova, Russia, Tajikistan, Uzbekistan) were investigated. METHODS: The lipase activity, dissolution, and particle size distribution of samples from multiple batches of pancreatin of different strengths were measured. RESULTS: Regarding lipase activities, all pancreatin preparations except Micrazim® matched the labeled content. Considerable differences were observed in particle size and dissolution. CONCLUSION: Pancreatin preparations available in Russia and CIS demonstrate product-to-product and batch-to-batch variability regarding the measured properties of lipase activity, dissolution, and particle size. This may impact the efficacy of PERT and therefore clinical outcomes.

Perinatal encephalopathy, the syndrome of intracranial hypertension and associated diagnostic labels in the Commonwealth of Independent States: a systematic review.

BACKGROUND: The WHO reports excessive rates of ill-defined neurological diagnoses and ineffective and potentially harmful drug treatments in children in the Commonwealth of Independent States (CIS). Collectively termed perinatal encephalopathy and the syndrome of intracranial hypertension (PE-SIH), these diagnoses are important contributors to perceived childhood morbidity and disability in the CIS. A systematic compilation of information on PE-SIH is lacking. METHODS: We systematically reviewed publications between 1970 and 2020 on PE-SIH in Azerbaijani, English, Russian and Ukrainian languages and summarised information on PE-SIH. RESULTS: We identified 30 publications (70% in Russian) published 1976-2017. The diagnosis of PE-SIH was either based on unreported criteria (67% of reports), non-specific clinical features of typically developing children or those with common developmental disorders (20% of reports) or cranial ultrasound (13% of reports). The reported proportion of children with PE-SIH in the study samples ranged from 31% to 99%. There were few published studies on reassessments of children diagnosed with PE-SIH, and these did not confirm neurological disease in the majority of children. Treatments included multiple unlicenced drugs without established effectiveness and with potential unwanted effects. CONCLUSION: This review suggests that PE-SIH is a medical diagnostic label that is used in numerous children without substantive associated disease. The diagnosis and treatment of PE-SIH is a multidimensional, iatrogenic, clinical and public health problem in the CIS. With increasing use of evidence-based medicine guidelines in the region, it is hoped that PE-SIH will gradually disappear, but actions to accelerate this change are nevertheless needed.

Cardiovascular Diseases in Central and Eastern Europe: A Call for More Surveillance and Evidence-Based Health Promotion.

Objectives: The paper aims to identify the priorities for cardiovascular health promotion research in Central and Eastern Europe (CEE), the region with the highest cardiovascular diseases (CVD) burden in the world. Methods: This narrative review covered peer-reviewed publications and online databases using a nonsystematic purposive approach. Results: In despite of a steady decrease in CVD burden in the region, the East-West disparities are still significant. There is minimal continuity in the past and current CVD prevention efforts in the region. Many challenges still exist, including an opportunity gap in research funding, surveillance and population-based preventive interventions. A comprehensive approach focusing on multisectoral cooperation, quality and accessibility of healthcare and equity-oriented public policies and supported by well-designed epidemiologic studies is needed to overcome these challenges. Conclusion: The current level of effort is not adequate to address the magnitude of the CVD epidemic in CEE. It is imperative to strengthen the epidemiological base concerning cardiovascular health in the region, to foster surveillance and progress in implementation of CVD preventive strategies in the most affected populations of Europe.

Consensus on management of hepatitis C virus infection in resource-limited Ukraine and Commonwealth of Independent States regions.

Globally, 69.6 million individuals were infected with hepatitis C virus (HCV) infection in 2016. Of the six major HCV genotypes (GT), the most predominant one is GT1, worldwide. The prevalence of HCV in Central Asia, which includes most of the Commonwealth of Independent States (CIS), has been estimated to be 5.8% of the total global burden. The predominant genotype in the CIS and Ukraine regions has been reported to be GT1, followed by GT3. Inadequate HCV epidemiological data, multiple socio-economic barriers, and the lack of region-specific guidelines have impeded the optimal management of HCV infection in this region. In this regard, a panel of regional experts in the field of hepatology convened to discuss and provide recommendations on the diagnosis, treatment, and pre-, on-, and posttreatment assessment of chronic HCV infection and to ensure the optimal use of cost-effective antiviral regimens in the region. A comprehensive evaluation of the literature along with expert recommendations for the management of GT1-GT6 HCV infection with the antiviral agents available in the region has been provided in this review. This consensus document will help guide clinical decision-making during the management of HCV infection, further optimizing treatment outcomes in these regions.

Sharing knowledge on the treatment of childhood cancer.

The Russian Federation is sharing lessons drawn from 30 years of treating childhood cancer, transferring knowledge to fellow Commonwealth of Independent States countries and beyond. Andrey Shukshin reports.

[Analysis of HIV-1 (Human immunodeficiency virus-1, Lentivirus, Orthoretrovirinae, Retroviridae) Nef protein polymorphism of variants circulating in the former USSR countries.]

INTRODUCTION: The human immunodeficiency virus (HIV) Nef protein is one of the key factors determining the infectivity and replicative properties of HIV. With the ability to interact with numerous proteins of the host cell, this protein provides the maximum level of virus production and protects it from the immune system. The main activities of Nef are associated with a decrease in the expression of the CD4 receptor and major histocompatibility complex class I molecules (MHC-I), as well as the rearrangement of the cytoskeleton. These properties of the protein are determined by the structure of several motifs in the structure of the nef gene encoding it, which is quite variable. OBJECTIVES: The main goal of the work was to analyze the characteristics of Nef protein of HIV-1 variant A6, which dominates in the countries of the former USSR. The objective of the work was a comparative analysis of natural polymorphisms in the nef gene of HIV-1 sub-subtypes A6 and A1 and subtype B. MATERIAL AND METHODS: The sequences of the HIV-1 genome obtained during the previous work of the laboratory were used, as well as the reference sequence from GenBank. In this work, Sanger sequencing and new generation sequencing methods, as well as bioinformation analysis methods were used. RESULTS AND DISCUSSION: The existence of noticeable differences in the prevalence of Nef natural polymorphisms (A32P, E38D, I43V, A54D, Q104K, H116N, Y120F, Y143F, V168M, H192T, V194R, R35Q, D108E, Y135F, E155K, E182M, R184K and F191L), some of which are characteristic mutations for variant A6, was shown. CONCLUSION: Characteristic substitutions were found in the Nef structure, potentially capable of weakening the replicative properties of HIV-1 variant A6.

Panel estimation for renewable and non-renewable energy consumption, economic growth, CO2 emissions, the composite trade intensity, and financial openness of the commonwealth of independent states.

This article investigates the long-run and causal linkages between economic growth, CO2 emissions, renewable and non-renewable (fossil fuels) energy consumption, the Composite Trade Intensity (CTI) as a proxy for trade openness, and the Chinn-Ito index as a proxy for financial openness for a panel of the Commonwealth of Independent States (CIS) region including Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia, Tajikistan, Turkmenistan, Ukraine, and Uzbekistan over the period of 1992-2015. It is the first time that CTI and the Chinn-Ito indexes are used in an economic-pollution model. Employing three panel unit root tests, panel cointegration estimation methods (DOLS and FMOLS), and two panel causality tests, the main empirical results provided evidence for the bidirectional long-run relationship between all the variables in all 12 sampled countries except for economic growth-renewable energy use linkage. The findings of causality tests indicated that there is a unidirectional short-run panel causality running from economic growth, financial openness, and trade openness to CO2 emissions and from fossil fuel energy consumption to renewable energy use.

Patient Access, Unmet Medical Need, Expected Benefits, and Concerns Related to the Utilisation of Biosimilars in Eastern European Countries: A Survey of Experts.

This policy research aims to map patient access barriers to biologic treatments, to explore how increased uptake of biosimilars may lower these hurdles and to identify factors limiting the increased utilisation of biosimilars. A policy survey was developed to review these questions in 10 Central and Eastern European (CEE) and Commonwealth of Independent States (CIS) countries. Two experts (one public and one private sector representative) from each country completed the survey. Questions were related to patient access, purchasing, clinical practice, and real-world data collection on both original biologics and biosimilars. Restrictions on the number of patients that can be treated and related waiting lists were reported as key patient access barriers. According to respondents, for both clinicians and payers the primary benefit of switching patients to biosimilars would be to treat more patients. However, concerns with therapeutic equivalence and fear of immunogenicity may reduce utilisation of biosimilars. Similar limitations in patient access to both original biologics and biosimilars raise concerns about the appropriateness and success of current biosimilar policies in CEE and CIS countries. The conceptual framework for additional real-world data collection exists in all countries which may provide a basis for future risk-management activities including vigorous pharmacovigilance data collection.

Molecular epidemiology of HIV-1 subtype A in former Soviet Union countries.

While in other parts of the world it is on decline, incidence of HIV infection continues to rise in the former Soviet Union (FSU) countries. The present study was conducted to investigate the patterns and modes of HIV transmission in FSU countries. We performed phylogenetic analysis of publicly available 2705 HIV-1 subtype A pol sequences from thirteen FSU countries: Armenia, Azerbaijan, Belarus, Estonia, Georgia, Kazakhstan, Kyrgyzstan, Latvia, Lithuania, Moldova, Russia, Ukraine and Uzbekistan. Our analysis showed that the clusters from FSU countries were intermixed, indicating a possible role of transmigration in HIV transmission. Injection drug use was found to be the most frequent mode of transmission, while the clusters from PWID and heterosexual transmission were intermixed, indicating bridging of HIV infection across populations. To control the expanding HIV epidemic in this region, harm reduction strategies should be focused on three modes of transmission, namely, cross-border migration, injection drug use and heterosexual.

The epidemiological transition in Eastern and Western Europe: a historic natural experiment.

Background: The continent of Europe has experienced remarkable changes in the past 25 years, providing scope for natural experiments that offer insight into the complex determinants of health. Methods: We analysed trends in life expectancy at birth in three parts of Europe, those countries that were members of the European Union (EU) prior to 2004, countries that joined the European Union since then, and the twelve countries that emerged from the Soviet Union to form the Commonwealth of Independent States (CIS). The contribution of deaths at different ages to these changes was assessed using Arriaga's method of decomposing changes in life expectancy. Results: Europe remains divided geographically, with an East-West gradient. The former Soviet countries experienced a marked initial decline in life expectancy and have only recovered after 2005. However, the situation for those of working ages is little better than in 1990. The pre-2004 EU has seen substantial gains throughout the past 25 years, although there is some evidence that this may be slowing, or even reversing, at older ages. The countries joining the EU in 2004 subsequently began to see some improvements in the early 1990s, but have experienced larger gains since 2000. Conclusions: Europe offers a valuable natural laboratory for understanding the impact of political, economic, and social changes on health. While the historic divisions of Europe are still visible, there is also evidence that individual countries are doing better or worse than their neighbours, providing many lessons that can be learned from.

Measurement of 239Pu in keratinous materials: A potential non-invasive bioassay for monitoring human exposure.

The use of hair, toenail, and fingernail as non-invasive monitors of occupational and environmental exposure to 239Pu are reported. Volunteers from US national laboratories and individuals with suspected environmental exposure to Pu were recruited to participate in the study. The exposure history of cases was assessed using a short questionnaire. Levels of Pu in keratinous materials collected from the exposed individuals were above the limit of detection in 5 of 7 cases with concentrations ranging from 0.055 to 0.78ng/kg. To our knowledge, this is the first time that Pu has been measured in hair and nail samples collected from actinide workers in the United States. The 239Pu levels in the hair and nails collected from the exposure group are comparable to individuals from Minsk, Belarus and Dubna, Russia and lower than individuals living near the Semipalatinsk region of Kazakhstan and in the Gomel region of Belarus.

Understanding patient and physician perceptions of benign prostatic hyperplasia in Asia Pacific, Latin America and the Commonwealth of Independent States: the Prostate Research on Behaviour and Education (PROBE) II survey.

AIM: To assess attitudes and beliefs towards benign prostatic hyperplasia (BPH)/ lower urinary tract symptoms (LUTS) and its treatment among patients and physicians in Latin America, Asia Pacific and the Commonwealth of Independent States (CIS). METHODS: Cross-sectional, quantitative study conducted between December 2014 and September 2015. Separate questionnaires were administered to BPH/LUTS patients receiving drug treatment for their condition and to practising physicians who treat patients with BPH/LUTS. RESULTS: In total, 1094 patients and 202 physicians completed a questionnaire. Most patients (61%) felt very/fairly well informed about BPH/LUTS, and 60% of physicians perceived patients to be very/somewhat informed. Overall, 70% of physicians felt that it would be valuable to raise awareness of BPH/LUTS and encourage men to consult a physician. The first symptoms most commonly noticed by patients were need to urinate more frequently, slower/weaker stream and nocturia. At first consultation, 71% of patients recalled providing a urine sample, 57% having a blood test for prostate-specific antigen and 56% a digital rectal examination being performed. Over two thirds of patients (69%) were satisfied with their current medication; highest satisfaction rates (among both patients and physicians) were reported for alpha blockers and 5ARIs, either as monotherapies or used in combination. Patients were prepared to wait longer for symptom relief in order to have a reduced risk of surgery. Most physicians (90%) thought that at least some patients believe BPH/LUTS to be a progressive condition. Most physicians thought that patients were very/fairly concerned about BPH surgery (92%) and acute urinary retention (72%); 52% of physicians thought treatment adherence was "extremely" important. CONCLUSIONS: This study provides valuable insights into the attitudes and beliefs of patients and physicians in Asia Pacific, Latin America and CIS about BPH/LUTS and its management. It also highlights areas of discordance between patient/physician perceptions and beliefs about BPH/LUTS, and potential areas of focus to improve the experience of affected patients.

[On improvement of the mechanism for establishing and changing indicators of quality and food safety in the regulatory and legal acts of the Eurasian Economical Union].

In accordance with the Treaty on the Eurasian Economic Union (EAEU) to ensure the sanitary and epidemiological welfare of the population within the Union, a coordinated policy in agreed policy in the sphere of application of sanitary measures is carried out. Sanitary measures are the obligatory requirements and procedures, including requirements for the final product, processing methods, production, transportation, storage and disposal, sampling procedures, methods of research (tests), risk assessment, the state registration, requirements for packaging directly aimed at ensuring the safety of products (goods) in order to protect human welfare, and they should be applied on the basis having a scientific explanation, and only to the extent that is necessary to protect human welfare. Sanitary measures applied within the Union should be based on international and regional standards, guidelines and (or) the recommendations, except when they based on appropriate scientific studies and explanations. In this case sanitary measures which could provide a higher level of sanitary protection are introduced. At present, the mechanism of the development, justification and approval of common sanitary and epidemiological requirements (ESR) and procedures of the Eurasian Economic Commission (the Commission) is not installed. The absence of a clear mechanism for the development, approval and implementation of the ESR to the products (goods) on the basis having a scientific explanation on the one hand could lead to the creation of unjustified barriers to foreign and mutual trade, on the other--to weaken the level of safety for human life and health of products (goods) placed on markets of the Union. In order to bring the regulatory legal acts of the Customs Union in accordance with the Treaty on the Eurasian Economic Union the Commission in cooperation with the competent authorities of the Member States in the field of sanitary and epidemiological welfare developed the project of Guidelines for development, approval, modification and application of common sanitary epidemiological and hygienic requirements and procedures (hereinafter--Guidelines) which is currently undergoing approval procedures. The project envisages that the Uniform sanitary requirements are established on the basis of scientific research, including the evaluation of the risk of harmful effects of the environment on the human factors, taking into consideration the analysis of international experience in order to harmonize common sanitary requirements with international standards, guidelines and (or) recommendations. Adoption of the draft Guidelines, as well as the application of common methodologies of risk assessment and the hygienic standardization in establishing and justifying safety performance of products (goods) in the Eurasian Economic Union allow quickly and transparently develop, validate, coordinate and approve the Uniform sanitary and epidemiological and hygienic requirements and procedures for sanitary inspection (control) of products (goods) and include them into technical regulations Union.

Spousal Violence in 5 Transitional Countries: A Population-Based Multilevel Analysis of Individual and Contextual Factors.

OBJECTIVES: I examined the individual- and community-level factors associated with spousal violence in post-Soviet countries. METHODS: I used population-based data from the Demographic and Health Survey conducted between 2005 and 2012. My sample included currently married women of reproductive age (n = 3932 in Azerbaijan, n = 4053 in Moldova, n = 1932 in Ukraine, n = 4361 in Kyrgyzstan, and n = 4093 in Tajikistan). I selected respondents using stratified multistage cluster sampling. Because of the nested structure of the data, multilevel logistic regressions for survey data were fitted to examine factors associated with spousal violence in the last 12 months. RESULTS: Partner's problem drinking was the strongest risk factor associated with spousal violence in all 5 countries. In Moldova, Ukraine, and Kyrgyzstan, women with greater financial power than their spouses were more likely to experience violence. Effects of community economic deprivation and of empowerment status of women in the community on spousal violence differed across countries. Women living in communities with a high tolerance of violence faced a higher risk of spousal violence in Moldova and Ukraine. In more traditional countries (Azerbaijan, Kyrgyzstan, and Tajikistan), spousal violence was lower in conservative communities with patriarchal gender beliefs or higher financial dependency on husbands. CONCLUSIONS: My findings underscore the importance of examining individual risk factors in the context of community-level factors and developing individual- and community-level interventions.

[Training of medical physicists in radiation therapy at the International Educational Center of the Association of Medical Physicists in Russia].

The efficiency of radiotherapy treatment for cancer patients and use of the state-of-the-art accelerator facilities, in the first place, depends on the qualification and number of medical physicists. The need for the training and continuing professional development (CPD) of medical radiation physicists in Russia and CIS countries has dramatically increased today. The article considers the system of refresher training which should provide the continuing professional development and advance training of medical radiation physicists. The authors analyze the experience of the International Educational Center of the Association of Medical Physicists in Russia involved in the CPD of medical physicists under the IAEA TC projects, RMAPO and N.N. Blokhin RCRC joint educational programs.