Exploring the burden and support needs of informal caregivers for the older adults in Kazakhstan: a mixed-methods study protocol.

Background: The growing population of older adults, often affected by chronic illnesses, disabilities, or frailty has led to a substantial increase in the need for informal caregivers. Objective: This paper is a protocol for a study that aims to investigate the effects of caregiving on informal caregivers of older adults in Kazakhstan with special emphasis on the cultural context. Methods: The protocol outlines a mixed-methods study that will be conducted in four cities in Kazakhstan. A total of 400 informal caregivers of older adults with two or more limitations in Activities of Daily Living (ADL) will be recruited to participate in a survey, aiming to evaluate care-related burdens and quality of life and health-related quality of life. The Institute for Medical Technology Assessment (iMTA) Valuation of Informal Care Questionnaire (iVICQ) was selected to be the main research instrument. Additionally, a subset of participants who express their willingness to participate will be selected from the pool of survey respondents to engage in semi-structured interviews, allowing for a deeper understanding of their experiences and providing insights into their social and medical support needs. Conclusion: This study will be the first investigation of the impact of caregiving on informal caregivers of older adults in Central Asia. The results will contribute to the literature by providing insights into older adults care within the specific national and cultural context of Kazakhstan with potential generalization to other Central Asian republics of the former USSR.

Prevalence of smoking before and during pregnancy and changes in this habit during pregnancy in Northwest Russia: a Murmansk county birth registry study.

BACKGROUND: Smoking during pregnancy leads to adverse maternal and birth outcomes. However, the prevalence of smoking among women in Russia has increased from < 5% in the 1980s to > 20% in the 2000s. We conducted a registry-based study in Murmansk County, Northwest Russia. Our aims were twofold: (i) assess the prevalence of smoking before and during pregnancy; and (ii) examine the socio-demographic factors associated with giving up smoking or reducing the number of cigarettes smoked once pregnancy was established. METHODS: This study employs data from the population-based Murmansk County Birth Registry (MCBR) collected during 2006-2011. We used logistic regression to investigate associations between women's socio-demographic characteristics and changes in smoking habit during pregnancy. To avoid departure from uniform risk within specific delivery departments, we employed clustered robust standard errors. RESULTS: Of all births registered in the MCBR, 25.2% of the mothers were smokers before pregnancy and 18.9% continued smoking during pregnancy. Cessation of smoking during pregnancy was associated with education, marital status and parity but not with maternal age, place of residence, and ethnicity. Women aged ≤ 20-24 years had higher odds of reducing the absolute numbers of cigarettes smoked per day during pregnancy than those aged ≥ 30-34 years. Moreover, smoking nulliparae and pregnant women who had one child were more likely to reduce the absolute numbers of cigarettes smoked per day compared to women having ≥ 2 children. CONCLUSIONS: About 25.0% of smoking women in the Murmansk County in Northwest Russia quit smoking after awareness of the pregnancy, and one-third of them reduced the number cigarettes smoked during pregnancy. Our study demonstrates that women who have a higher education, husband, and are primiparous are more likely to quit smoking during pregnancy. Maternal age and number of children are indicators that influence reduction in smoking during pregnancy. Our findings are useful in identifying target groups for smoking intervention campaigns.

Two vicious circles contributing to a diagnostic delay for tuberculosis patients in Arkhangelsk.

SETTING: Delay in tuberculosis (TB) diagnosis increases the infectious pool in the community and the risk of development of resistance of mycobacteria, which results in an increased number of deaths. OBJECTIVE: To describe patients' and doctors' perceptions of diagnostic delay in TB patients in the Arkhangelsk region and to develop a substantive model to better understand the mechanisms of how these delays are linked to each other. DESIGN: A grounded theory approach was used to study the phenomenon of diagnostic delay. Patients with TB diagnostic delay and doctors-phthisiatricians were interviewed. RESULTS: A model named 'sickness trajectory in health-seeking behaviour among tuberculosis patients' was developed and included two core categories describing two vicious circles of diagnostic delay in patients with TB: 'limited awareness of the importance to contact the health system' and 'limited resources of the health system' and the categories: 'factors influencing health-seeking behaviour' and 'factors influencing the health system effectiveness'. Men were more likely to report patient delay, while women were more likely to report health system delay. CONCLUSIONS: To involve people in early medical examinations, it is necessary to increase alertness on TB among patients and to improve health systems in the districts.

Inequalities in self-rated health among 45+ year-olds in Almaty, Kazakhstan: a cross-sectional study.

BACKGROUND: Self-rated health (SRH) has been widely studied to assess health inequalities in both developed and developing countries. However, no studies have been performed in Central Asia. The aim of the study was to assess gender-, ethnic-, and social inequalities in SRH in Almaty, Kazakhstan. METHODS: Altogether, 1500 randomly selected adults aged 45 years or older were invited to participate in a cross-sectional study and 1199 agreed (response rate 80%). SRH was classified as poor, satisfactory, good and excellent. Multinomial logistic regression was applied to study associations between SRH and socio-demographic characteristics. Crude and adjusted odds ratios (OR) for poor vs. good and for satisfactory vs. good health were calculated with 95% confidence intervals (CI). RESULTS: Altogether, poor, satisfactory, good and excellent health was reported by 11.8%, 53.7%, 31.0% and 3.2% of the responders, respectively. Clear gradients in SRH were observed by age, education and self-reported material deprivation in both crude and adjusted analyses. Women were more likely to report poor (OR=1.9, 95% CI: 1.2-3.1) or satisfactory (OR=1.6, 95% CI: 1.2-2.1) than good health. Ethnic Russians and unmarried participants had greater odds for poor vs. good health (OR=2.3, 95% CI: 1.5-3.7 and OR=4.0, 95% CI: 2.7-6.1, respectively) and for satisfactory vs. good health (OR=1.4, 95% CI: 1.1-1.9 and OR=1.9, 95% CI: 1.4-2.5, respectively) in crude analysis, but the estimates were reduced to non-significant levels after adjustment. Unemployed and pensioners were less likely to report good health than white-collar workers while no difference in SRH was observed between white- and blue-collar workers. CONCLUSION: Considerable levels of inequalities in SRH by age, gender, education and particularly self-reported material deprivation, but not by ethnicity or marital status were found in Almaty, Kazakhstan. Further research is warranted to identify the factors behind the observed associations in Kazakhstan.

Road traffic fatalities in Arkhangelsk, Russia in 2005-2010: reliability of police and healthcare data.

PURPOSE: To estimate and compare reliability of traffic mortality data of the police and the healthcare sector in Arkhangelsk, Russia. METHODS: The study matched traffic mortality data of the police and the regional healthcare statistics centre for the period from 2005 to 2010. Individual investigations of unmatched cases were performed, and the underlying causes of the non-matches were established. The obtained distribution of non-matches by causes served as basis for estimating the true numbers of traffic fatalities in the two sources, in appliance with corresponding fatality definitions and registration rules. A data accuracy index (DAI) was calculated for each source by using an adapted version of the formula for calculating accuracy of a diagnostic test. This was used as a measure for data reliability. Time trends in annual DAIs were estimated for each source by χ(2)-test for linear trend. RESULTS: During the 6-year period, the police and the healthcare statistics centre registered 217 and 237 traffic fatalities in Arkhangelsk, respectively. Matching of data from the two sources resulted in 162 matched cases, 55 unmatched cases in the police data, and 75 unmatched cases in the healthcare data. More than a half (56%) of the non-matches were attributed to incompatibility of the definitions in the two data registration systems; 39% were attributed to failures in the healthcare data. Other non-matches were due to scarce identifying information (2%) or were not classifiable (2%). None of the non-matches were clearly attributable to failures in the police data. The 6-year DAI was 98% for the police data and 80% for the healthcare data. The DAI for the police data was stable over 2005-2010 (ranging from 96% to 100%). The DAI for the healthcare data increased from 66% in 2005 to 98% in 2010 (Ptrend<0.001). CONCLUSION: The findings suggest that traffic mortality data of the police were more reliable, compared to the healthcare data. However, reliability of the healthcare data was improving during the study period.

Prevalence of breast-feeding in the Norwegian Mother and Child Cohort Study and health service-related correlates of cessation of full breast-feeding.

OBJECTIVE: First, to describe the prevalence of both full and partial breast-feeding during the first 6 months; second, to study the associations between selected health service-related factors and cessation of full breast-feeding at three time intervals. DESIGN: Retrospective questionnaires, 6 months after birth. SETTING: The Norwegian Mother and Child Cohort Study (MoBa). SUBJECTS: In total, 29 621 women. RESULTS: While 96·6 %, 94·0 %, 90·8 %, 86·9 %, 83·8 % and 80·0 % of the infants were breast-fed at 1, 2, 3, 4, 5 and 6 months, respectively, the corresponding proportions for full breast-feeding were 84·6 %, 79·1 %, 70·9 %, 44·0 %, 16·7 % and 2·1 %. An increased risk of cessation of full breast-feeding during the first month was associated with supplementation during the first week of life with water (relative risk (RR) 1·77; 95 % CI 1·52, 2·06), sugar water (RR 1·73; 95 % CI 1·49, 2·00) or formula (RR 5·99; 95 % CI 5·58, 6·42). An increased risk was also associated with Caesarean delivery (RR 1·08; 95 % CI 1·00, 1·16) and breast-feeding problems (RR 1·56; 95 % CI 1·45, 1·67). Between months 1 and 3, the risk of cessation of full breast-feeding remained elevated in the case of supplementation during the first week of life with water (RR 1·29; 95 % CI 1·14, 1·45), sugar water (RR 1·48; 95 % CI 1·34, 1·64) or formula (RR 1·18; 95 % CI 1·07, 1·29). The same applied to Caesarean delivery (RR 1·15; 95 % CI 1·06, 1·25). CONCLUSIONS: Supplementation during the first week, breast-feeding problems and Caesarean delivery are associated with early cessation of full breast-feeding. The results support a cautious approach to supplementation during the first week of life.

Congestion road tax and physical activity.

BACKGROUND: Large-scale policy and environmental changes, such as congestion road taxes, may be a way to promote active transportation. PURPOSE: This study aimed to examine the potential effect of a congestion road tax on physical activity. METHODS: Baseline data were collected during October-November 2003, follow-up data in May 2006, and analysis was performed in September 2008. The short self-administered version of the International Physical Activity Questionnaire was used to assess physical activity. Data from those with access to motorized vehicles in the Stockholm region (n=165), where the tax was in place, were compared with those from the Göteborg/Malmö regions (n=138). Within each region before and during the road tax implementation, the data were analyzed for differences in time spent at different intensity levels of physical activity, in addition to sitting, as well as for changes in reported time in overall (weighted) physical activity. RESULTS: There were no significant differences in the magnitude of the changes of the intensity levels of physical activity, weighted overall physical activity, or sitting, between Stockholm and Göteborg/Malmö. Among those exposed to the congestion road tax and with access to motorized vehicles, an increase in moderate physical activity (p=0.036); overall physical activity (p=0.015); and a reduction in time spent sitting (p=0.009) was observed. No differences were observed among those unexposed. CONCLUSIONS: The results from this study on the influence of a congestion road tax on levels of physical activity, though inconclusive, suggest that policy changes such as a congestion road tax might promote improvements in physical activity levels in individuals with motorized vehicles.

Adherence to physical activity recommendations and the influence of socio-demographic correlates - a population-based cross-sectional study.

BACKGROUND: Current physical activity guidelines acknowledge the importance of total health enhancing physical activity (HEPA) compared to leisure time physical activity or exercise alone. Assessing total HEPA may result in different levels of adherence to these as well as the strength and/or direction of associations observed between total HEPA and socio-demographic correlates. The aim of this study was to estimate the proportion of the population adhering to the recommendation of at least 30 minutes of HEPA on most days, and to examine the influences of socio-demographic correlates on reaching this recommendation. METHODS: Swedish adults aged 18-74 years (n = 1470) were categorized, based on population data obtained using the IPAQ, into low, moderately and highly physically active categories. Independent associations between the physical activity categories and socio-demographic correlates were studied using a multinomial logistic regression. RESULTS: Of the subjects, 63% (95% CI: 60.5-65.4) adhered to the HEPA recommendation. Most likely to reach the highly physical active category were those aged < 35 years (OR = 1.8; 95% CI: 1.1-3.3), living in small towns (OR = 1.8; 95% CI: 1.1-2.7) and villages (OR = 2.4; 95% CI: 1.6-3.7), having a BMI between 25.0-29.9 kg/m2 (OR = 2.7; 95% CI: 1.4-5.3) having a BMI < 25 kg/m2 (OR = 2.5; 95% CI: 1.3-4.9), or having very good (OR = 2.1; 95% CI: 1.3-3.3) or excellent self-perceived health (OR = 4.1; 95% CI: 2.4-6.8). Less likely to reach the high category were women (OR = 0.6; 95% CI: 0.5-0.9) and those with a university degree (OR = 0.5; 95% CI: 0.3-0.9). Similar, but less pronounced associations were observed for the moderate group. Gender-specific patterns were also observed. CONCLUSION: Almost two-thirds of the Swedish adult population adhered to the physical activity recommendation. Due to a large diversity in levels of physical activity among population subgroups, social-ecological approaches to physical activity promotion may be warranted.

Socio-demographic determinants of initiation and duration of breastfeeding in northwest Russia.

AIM: This study examines socio-demographic determinants of initiation and duration of breastfeeding in a community-based cohort in northwest Russia. METHODS: All infants born to women who were registered at the antenatal clinics in Severodvinsk in 1999 comprised the cohort (n=1399) and were followed up at 1 y. Data on maternal and infant characteristics as well as the duration of breastfeeding were obtained from medical records. Proportional hazard analysis was applied to quantify the effect of the selected factors on the risk of breastfeeding discontinuation adjusted for potential confounders. RESULTS: Only 1.3% of infants were never breastfed. Breastfeeding rates were 75.0% and 47.2% at 3 and 6 mo, respectively. Maternal age and early initiation of prenatal care were positively associated with breastfeeding initiation rates. Increased risks of breastfeeding discontinuation were found in teenage mothers (OR=1.45, 95% CI: 1.06-1.99), in mothers with basic education (OR=1.68, 95% CI: 1.06-2.66) and in unmarried mothers (OR=1.19, 95% CI: 1.03-1.38). Women with no previous deliveries were more likely to breastfeed longer (OR=0.74, 95% CI: 0.62-0.90). CONCLUSIONS: Compared with previous studies in Russia, almost universal initiation and considerably higher rates of breastfeeding at specific time points were found. Social variations in initiation and duration of breastfeeding should raise concern of inequalities in breastfeeding practices in transitional Russia.

Social variations in infant growth performance in Severodvinsk, Northwest Russia: community-based cohort study.

AIM: To examine infant growth characteristics and their socio-demographic determinants in Severodvinsk, northwest Russia. METHODS: Length-for-age, weight-for-age, and weight-for-length Z-scores of 1,067 infants born in 1999-2000 in Severodvinsk were calculated on the basis of the data on the length and weight obtained from the medical files. Multiple linear regression was used to estimate independent effects of maternal age, education, occupation, marital status, weight, parity, sex of the baby, and breastfeeding duration on infant growth. RESULTS: At the age of 12 months, 1.1% of the infants were stunted, 1.1% underweight, and 0.5% wasted in comparison with the Centers for Disease Control and Prevention 2000 reference population. The mean Z-scores for length-for-age, weight-for-age, and weight-for-length were 0.48+/-0.93, 0.38+/-1.04, and 0.65+/-1.03, respectively. Mean weight-for-length Z-scores considerably increased from birth to 12 months, while length-for-age Z-score remained largely unchanged. In regression analysis, length-for-age Z-scores were lower by 0.43 (p=0.028) and by 0.30 (p<0.001) in infants born to mothers with basic and unknown education, respectively. Positive trends between linear growth and maternal age (p=0.027) and education (p=0.024) were observed. No social variations in weight-for-length Z-scores were found. CONCLUSION: Prevalence of stunting, underweight, and wasting were lower than previously reported from Russia, which may reflect good overall socio-economic conditions in the town. Social variations in linear growth indicate the existence of inequalities in infant health, which may further increase with age.

Social variations in fetal growth in a Russian setting: an analysis of medical records.

PURPOSE: The study examines variations in fetal growth by maternal social circumstances in a Russian town. METHODS: All pregnant women registered at the antenatal clinics in 1999 in Severodvinsk (north-west Russia) and their live born infants comprised the study base (n=1399). Multivariate linear regression analysis was applied to quantify the effect of socio-demographic factors on birthweight and the ponderal index (PI). RESULTS: A clear gradient of birthweight in relation to mothers' education was revealed. Babies of the most educated mothers were 207 g (95% CI, 55, 358) heavier than babies of mothers with basic education. The average weight of those born to mothers with secondary and vocational levels of education was 172 g (95% CI, 91, 253) and 83 g (95% CI, 9, 163) lower compared with infants born to mothers with a university level of education after adjustment for age, parity, pre-pregnancy weight, marital status, maternal occupation, length of gestation, and sex of the baby. Maternal education also influenced the PI. CONCLUSIONS: Further studies should focus on the mechanisms of the coherence of maternal education and fetal growth. To ensure that all parts of the society benefit equally from economic and social reforms, social variations in pregnancy outcomes should be monitored during the time of transition.