Utilization of health care services by migrants in Europe-a systematic literature review.

Introduction: Our study reviewed the empirical evidence on the utilization of health care services by migrants in Europe, and on differences in health service utilization between migrants and non-migrants across European countries. Sources of data: A systematic literature review was performed, searching the databases Medline, Cinahl and Embase and covering the period from January 2009 to April 2016. The final number of articles included was 39. Areas of agreement: Utilization of accident and emergency services and hospitalizations were higher among migrants compared with non-migrants in most countries for which evidence was available. In contrast, screening and outpatient visits for specialized care were generally used less often by migrants. Areas of controversy: Utilization of general practitioner services among migrants compared with non-migrants presents a diverging picture. Growing points: Compared with previous systematic reviews, the results indicate a clearer picture of the differences in health service utilization between migrants and non-migrants in Europe. Areas timely for developing research: A comprehensive comparison across European countries is impossible because the number of studies is still limited. Further research should also help to identify barriers regarding the utilization of health care services by migrants.

Ethnic differences in all-cause mortality rates in Kazakhstan.

OBJECTIVES: This article explores mortality rates in Kazakhstan by ethnic group and some of the potential lifestyle factors that might help to explain the observed differences on a population level. STUDY DESIGN: Repeated cross-sectional data analysis. METHODS: We calculated age-standardized mortality rates from all causes by ethnic group, gender and age for 2009-2012. We analysed data on self-reported alcohol and tobacco consumption and other lifestyle factors from the nationally representative 5th National Behavior Study, conducted in 2012. RESULTS: Age-standardized all-cause mortality rates are generally much higher among ethnic Russians than among ethnic Kazakhs, both among women and men and in rural as well as urban areas. These differences are most pronounced in the age group 20-59 years. Information on self-reported alcohol consumption and smoking by ethnic group, gender and age shows major differences between ethnic groups, with consistently higher rates of alcohol consumption and smoking among ethnic Russians, both in women and men and across all adult age groups. CONCLUSIONS: Policies to improve the health of the population of Kazakhstan must take account of ethnic differences.

Financing public health in europe.

AIM: The aim of this study was to ascertain the levels and mechanisms of funding public health in Europe. METHODS: A review of published and unpublished documents and expenditure data was undertaken. RESULTS: Expenditure on public health in Europe is difficult to determine, but data from national health accounts suggest that it differs greatly across countries, both as a percentage of total health expenditure and per capita. Better data are urgently needed, given that a lack of sustainable, long-term funding may be the most significant barrier to public health programmes and interventions in Europe. CONCLUSIONS: In view of the current economic crisis, it will be essential to safeguard financing for public health and to put it on a more sustainable basis.

Lessons from two decades of health reform in Central Asia.

Since becoming independent at the break-up of the Soviet Union in 1991, the countries of Central Asia have made profound changes to their health systems, affecting organization and governance, financing and delivery of care. The changes took place in a context of adversity, with major political transition, economic recession, and, in the case of Tajikistan, civil war, and with varying degrees of success. In this paper we review these experiences in this rarely studied part of the world to identify what has worked. This includes effective governance, the co-ordination of donor activities, linkage of health care restructuring to new economic instruments, and the importance of pilot projects as precursors to national implementation, as well as gathering support among both health workers and the public.

Investigation of a spatiotemporal cluster of verotoxin-producing Escherichia coli O157 infections in eastern England in 2007.

An outbreak of verotoxin-producing Escherichia coli O157 (VTEC O157) infections linked to an open farm occurred in eastern England in April and May 2007. This paper describes the investigation and highlights the importance of multidisciplinary collaboration for successful control of such outbreaks. There was a temporal cluster of 12 confirmed symptomatic cases of VTEC O157 and one asymptomatic carrier, from five families. The investigation revealed that four of these cases formed part of an outbreak involving two families who visited an open farm. The phenotypic and genotypic characteristics of the isolates from the two families and the putative farm animal contacts were indistinguishable, indicating that the animals were the source of the primary infections. No epidemiological link could be established between the remaining three families affected and the open farm or people having visited the farm. Control measures included improved hand washing facilities on the farm, information for visitors and staff, restricted access and suspended petting and feeding of animals, and thorough cleaning and disinfection of affected areas.