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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.
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Diabetes Mellitus , Hipertensión , Enfermedades no Transmisibles , Humanos , Enfermedades no Transmisibles/terapia , Atención Primaria de Salud , Comunidad de Estados Independientes , Diabetes Mellitus/terapia , Hipertensión/terapiaRESUMEN
В данном докладе отражены основные итоги второго технического совещания сети стран Содружества Независимых Государств (СНГ) по вопросам политики в отношении алкоголя, направленного на усиление деятельности по реализацииосновных приоритетных направлений Европейского плана действий ВОЗ по сокращению вредного употребления алкоголя. Совещание было проведено в виртуальном формате 20 октября 2020 г. и организовано программой «Алкоголь и запрещенные наркотики» Европейского регионального бюро ВОЗ. Совещание проводилось с целью предоставить странам СНГ возможность наладить взаимодействие, позволяющее поделиться опытом, успехами и проблемами, связанными с разработкой и реализацией политики контроля над алкогольной продукцией, которое послужило бы основой для координации усилий в будущем. Совещание также было направлено на то, чтобы обозначить конкретные проблемы в области контроля над алкогольной продукцией, вызванные пандемией COVID-19, и предоставить участникам платформу для ведения открытого диалога, призванную стать основой для регионального сотрудничества в этой области в будущем.
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Alcohólicos , Consumo de Bebidas Alcohólicas , Comunidad de Estados IndependientesRESUMEN
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.
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Dióxido de Carbono , Desarrollo Económico , África , Asia , Dióxido de Carbono/análisis , China , Comunidad de Estados Independientes , Europa (Continente) , India , Medio Oriente , América del Norte , América del SurRESUMEN
This report highlights the main outcomes of the second technical meeting of the Commonwealth of Independent States (CIS) Alcohol Policy Network, which aimed to strengthen implementation of key priority areas of the WHOEuropean Action Plan to Reduce the Harmful Use of Alcohol. The meeting was held virtually on 20 October 2020 and was organized by the Alcohol and Illicit Drugs programme of the WHO Regional Office for Europe. The goal of the meeting was to create a networking opportunity for CIS countries to highlight and share their experiences, successes and challenges with the development and implementation of alcohol control policies as a foundation for concerted action going forward. The meeting also aimed to emphasize specific challenges in alcohol control posed by the COVID-19 pandemic and provide a platform for participants to engage in open dialogue as a foundation for future regional collaboration in this area.
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Alcohólicos , Consumo de Bebidas Alcohólicas , Comunidad de Estados IndependientesRESUMEN
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.
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Fármacos Gastrointestinales/química , Fármacos Gastrointestinales/metabolismo , Lipasa/análisis , Lipasa/metabolismo , Pancreatina/química , Pancreatina/metabolismo , Comunidad de Estados Independientes , Liberación de Fármacos , Insuficiencia Pancreática Exocrina/tratamiento farmacológico , Fármacos Gastrointestinales/uso terapéutico , Humanos , Pancreatina/uso terapéutico , Tamaño de la Partícula , Preparaciones Farmacéuticas/análisis , Preparaciones Farmacéuticas/química , Federación de RusiaRESUMEN
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.
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Bebidas Alcohólicas , Etiquetado de Productos , Adolescente , Azerbaiyán , Niño , Comunidad de Estados Independientes , Femenino , Humanos , Kazajstán , Federación de Rusia , Tayikistán , UzbekistánRESUMEN
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.
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Encefalopatías/diagnóstico , Encefalopatías/terapia , Anticonvulsivantes/uso terapéutico , Encéfalo/diagnóstico por imagen , Comunidad de Estados Independientes , Suplementos Dietéticos , Diuréticos/uso terapéutico , Humanos , Lactante , Hipertensión Intracraneal/diagnóstico , Hipertensión Intracraneal/terapia , Nootrópicos/uso terapéutico , Vasoconstrictores/uso terapéuticoRESUMEN
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.
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Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/prevención & control , Monitoreo Epidemiológico , Política de Salud , Promoción de la Salud , Accesibilidad a los Servicios de Salud , Enfermedades Cardiovasculares/mortalidad , Comunidad de Estados Independientes/epidemiología , Dieta/estadística & datos numéricos , Europa (Continente)/epidemiología , Europa Oriental/epidemiología , Práctica Clínica Basada en la Evidencia , Equidad en Salud , Factores de Riesgo de Enfermedad Cardiaca , Humanos , Hipertensión/epidemiología , Obesidad/epidemiología , Calidad de la Atención de Salud , Conducta Sedentaria , Fumar/epidemiologíaRESUMEN
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.
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Antivirales/uso terapéutico , Consenso , Recursos en Salud/economía , Hepacivirus/patogenicidad , Hepatitis C Crónica/tratamiento farmacológico , Antivirales/economía , Toma de Decisiones Clínicas , Comunidad de Estados Independientes/epidemiología , Quimioterapia Combinada/economía , Quimioterapia Combinada/métodos , Gastroenterología/economía , Gastroenterología/métodos , Genotipo , Hepacivirus/genética , Hepatitis C Crónica/economía , Hepatitis C Crónica/epidemiología , Humanos , Factores Socioeconómicos , Respuesta Virológica Sostenida , Ucrania/epidemiologíaRESUMEN
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.
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Neoplasias/diagnóstico , Neoplasias/terapia , Niño , Comunidad de Estados Independientes , Detección Precoz del Cáncer , Humanos , Neoplasias/epidemiología , Federación de Rusia/epidemiologíaRESUMEN
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.
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Sustitución de Aminoácidos , Infecciones por VIH/epidemiología , VIH-1/genética , Polimorfismo Genético , Productos del Gen nef del Virus de la Inmunodeficiencia Humana/genética , Linfocitos T CD4-Positivos/inmunología , Linfocitos T CD4-Positivos/virología , Comunidad de Estados Independientes/epidemiología , Expresión Génica , Infecciones por VIH/inmunología , Infecciones por VIH/virología , VIH-1/clasificación , VIH-1/inmunología , Secuenciación de Nucleótidos de Alto Rendimiento , Interacciones Huésped-Patógeno/genética , Interacciones Huésped-Patógeno/inmunología , Humanos , Filogenia , Replicación Viral/inmunología , Productos del Gen nef del Virus de la Inmunodeficiencia Humana/metabolismoRESUMEN
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.
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Dióxido de Carbono/análisis , Energía Renovable/economía , Azerbaiyán , Dióxido de Carbono/química , Comunidad de Estados Independientes , Desarrollo Económico , Combustibles Fósiles , Georgia , Kazajstán , República de Belarús , Federación de Rusia , Tayikistán , UcraniaRESUMEN
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.
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Biosimilares Farmacéuticos/uso terapéutico , Equivalencia Terapéutica , Biosimilares Farmacéuticos/efectos adversos , Comunidad de Estados Independientes/epidemiología , Europa Oriental/epidemiología , Humanos , Farmacovigilancia , Encuestas y CuestionariosRESUMEN
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.
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Infecciones por VIH/virología , VIH-1/genética , Epidemiología Molecular , Comunidad de Estados Independientes/epidemiología , Genes Virales , Infecciones por VIH/epidemiología , Infecciones por VIH/transmisión , VIH-1/clasificación , Humanos , Filogenia , Factores de RiesgoRESUMEN
Бездымные табачные изделия представляют собой сложную и широко распространенную проблему для общественного здравоохранения, но этой проблеме до сих пор во всем мире уделяется ограниченное внимание. В Европейском регионе ВОЗ две группы населения имеют длительную традицию употребления бездымного табака – жители скандинавских стран, особенно Швеции, где традиционно употребляется снюс, и жители стран Центральной Азии, таких как Кыргызстан и Узбекистан, где наиболее популярной формой бездымного табака является насвай. Этот краткий документ посвящен употреблению бездымного табака, в частности употреблению насвая в Содружестве Независимых Государств. В документе анализируются последние имеющиеся данные о распространенности бездымного табака и предлагаются доступные варианты ответных мер политики.
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Tabaco sin Humo , Uso de Tabaco , Comunidad de Estados Independientes , Europa (Continente)RESUMEN
Smokeless tobacco products present a complex and widespread challenge to public health but have so far received limited attention globally. In the WHO European Region, two populations have a longstanding tradition of smokeless tobacco use – people in Scandinavian countries, particularly Sweden, where snus is traditionally consumed, and those in central Asian countries such as Kyrgyzstan and Uzbekistan, where nasvay is the most widely used form of smokeless tobacco. This brief paper looks at smokeless tobacco use, specifically the use of nasvay, in the Commonwealth of Independent States. It considers the latest available smokeless tobacco prevalence data and specifies the available policy responses.
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Tabaco sin Humo , Uso de Tabaco , Comunidad de Estados Independientes , Europa (Continente)RESUMEN
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.
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Esperanza de Vida/tendencias , Longevidad , Mortalidad/tendencias , Determinantes Sociales de la Salud/etnología , Asia Central , Comunidad de Estados Independientes , Europa (Continente)/epidemiología , Europa Oriental , Unión Europea , Femenino , Indicadores de Salud , Humanos , MasculinoRESUMEN
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.