Perception of neighborhood environment and health risk behaviors in Prague's teenagers: a pilot study in a post-communist city.

BACKGROUND: A youths' neighborhood can play an important role in their physical, health, and emotional development. The prevalence of health risk behavior (HRB) in Czech youth such as smoking, drug and alcohol use is the highest in Europe. AIM: To analyze differences in HRB in youth residents within different types of Prague's neighborhoods in relation to the perception of the built environment, quality of their school and home environments. DATA AND METHODS: The data is based on the on-line survey among elementary school students aged between 14-15 years, which was administered in19 selected schools in Prague, during the months of October 2013 to March 2014. Respondents were asked their opinions on various issues related to their HRB, about their indoor and outdoor housing and school environments. The questionnaire was completed by 407 students. Factor analysis with a principal components extraction was applied to determine the underlying structure in the variables. A consequent field research was conducted to map the opportunity hot spots and critical places around the elementary schools. RESULTS: Binge drinking has been reported mainly by the students living in the housing estates with blocks of flats. The most frequent occurrence of daily smokers was found in the neighborhoods of old city apartment houses. High prevalence of risky marijuana use almost in all the surveyed types of neighborhoods. The respondents were more critical in their evaluation of school characteristics. The neighborhoods critically evaluated by the students as regards the school outdoor environments were the older apartment houses in the historical centre and inner city, the school indoor environment was worst assessed within the housing estate neighborhoods. CONCLUSIONS: Our results suggest that perceptions of problems in both residential and school environment are associated with HRB. This fact makes this issue of a serious importance also from the policy point of view. Mainly the school surroundings have to be better managed by the local authorities responsible for the public space. This research thus forms part of the Sophie project aiming to find the most efficient policies that would tackle with the inequalities in the health and quality of life.

Post-Soviet transition: improving health services delivery and management.

During the post-Soviet transition of the last 2 decades, ex-Communist countries of the Eastern Bloc, including eastern and central Europe, the Soviet Union, and its satellite and aligned states, have undergone major health system reforms. Many health systems of those countries--previously adopting a Soviet-type Semashko model--are currently called "in transition," as reform agendas, such as shifting to a Bismarck, Beveridge, or mixed financing scheme or adopting new health delivery management policies, are still in development. In this article, we first review common characteristics of Semashko health systems (the predominant health system of Communist countries during the Soviet era) and then discuss the "new public management" principles that ex-Communist countries have recently started to adopt with various degrees of success. We then illustrate experiences with these principles using 2 case studies, from Russia and Albania, and propose health policy options for both cases. Based on a review of the literature and on the our work experience in Russia and Albania, we found that the 2 ex-Semashko systems have not fully capitalized on expected positive outcomes of new public management principles due to low local healthcare financing levels, depreciated healthcare infrastructure and operational capacities, overlapping and contradicting ideology and policies of the former and newer health systems, and finally, lack of leadership that has successful experience with these principles. In the case of pharmaceutical pricing, reimbursement, and access in Russia, we show how a well-intentioned but suboptimally designed and managed pharmaceutical coverage scheme has suffered moral hazard and adverse selection and has adversely impacted the new public management promise of efficient medicine coverage. In the case of Albania, the delayed investment in human resource reform within a depreciated and underfinanced delivery system has adversely affected the implementation of new public management principles.

Ethnic intermarriage in times of social change: the case of Latvia.

We gain insight into the dynamics of ethnic intermarriage in times of social change by studying marriages between Latvians and Russians (including Belarussians and Ukrainians) that occurred in Latvia before and after independence from the Soviet Union. Before independence, ethnic intermarriage was already rather common, involving about 17% of the marriages annually. Since independence, intermarriage between Russians and Latvians has increased substantially. Part of this increase can be explained by selective emigration, but at least half of it may be due to integrative processes. Although there were more marriages between Russian men and Latvian women before independence, the gender pattern reversed after independence. Intermarriage levels were the highest among the less educated, children of mixed couples, partners with similar educational levels, and people in the countryside.

The current availability of neurological in-patient services in post-communist central and eastern European countries.

BACKGROUND AND PURPOSE: Limited information can be obtained as to the availability of neurological in-patient services in the former communist countries of Eastern and Central Europe. The objective was to analyse data received directly from representatives of the particular countries. METHODS: The data were collected under the auspices of the 'First European Cooperation Neurology Workshop' held in April 2000, in Trest, Czech Republic. Neurologists from 15 post-communist countries provided information from their respective countries. Linear trends in graphs including the reliability value R(2) were used in the analysis of correlations. RESULTS: Data from 14 countries were assembled and trends were analysed. CONCLUSIONS: Direct relationships were found between: (1) the average department size and the average catchment area (R(2) = 0.1015); (2) the percentage of districts with a neurological in-patient department and the gross national product (GNP) per capita (R(2) = 0.1359); (3) the average neurological department size and the GNP per capita (R(2) = 0.1135), and (4) the average length of treatment and the number of neurological beds/100,000 inhabitants (R(2) = 0.1745). Inverse relationships were found between: (1) the number of neurological beds/100,000 inhabitants and the average hospital catchment area (R(2) = 0.2105), and (2) the number of neurological beds/100,000 inhabitants and the GNP per capita (R(2) = 0.1144).

Periodontal treatment needs in Central and Eastern Europe.

The aim of the present review is to evaluate the periodontal conditions and treatment needs in Central and Eastern Europe and to compare these data to the epidemiological data from the industrialised and developing countries. The recent prevalence and severity data provided by national surveys based on the CPITN methods are summarised. The periodontal conditions in the age groups 15-19 and 35-44 are discussed in detail. The CPITN data show no major differences in the extent and severity of destructive periodontal disease in different countries. In the age group 15-19 just a few European surveys reported 'score 4 sextant' and the prevalence of 'score 3' sextants was also below 10% in each survey. However calculus formation and bleeding on probing were very frequent findings both in Western and Eastern Europe. In the age group 35-44 the average prevalence of 'score 4 sextant' in Western and Eastern Europe were comparable while the proportion of periodontally absolutely healthy individuals was lower in Eastern Europe than in the Western part of the Continent. Five to 20% of the populations are affected by destructive periodontitis at the age of 40. This indicates the magnitude of the disease as a public health problem both in the industrialised West and the Eastern European countries. The same 10-15% prevalence rate of destructive periodontitis imposes a great challenge to the health authorities of these post-communist countries amid social and economic transition, because the nationwide preventive and basic periodontal therapeutic measures should be managed and financed from a substantially lower GDP than in the industrialised West.