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An assessment of the occupational and environmental health needs in seven Southeastern European and West-Central Asian countries.

ABSTRACT: Eastern European and Central Asian countries are undergoing rapid socioeconomic and political reforms. Many old industrial facilities are either abandoned, or use outdated technologies that severely impact the environment. Emerging industries have less regulation than in developed countries and environmental and occupational problems seem to be increasing. Under a US National Institutes of Health pilot grant, we developed an interdisciplinary One Health research network in Southeastern Europe and West-Central Asia to identify environmental and occupational problems. From 2012 to 2014, this GeoHealth Hub engaged 11 academic centers and 16 public health institutions in eight different countries: Albania, Armenia, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Romania, and the United States with a goal of strengthening environmental and occupational research and training capacities. Employing face-to-face interviews and large group meetings, we conducted an evidenced-based needs and opportunities assessment focused on aquatic health, food safety, and zoonotic diseases. Comprehensive reviews of the published literature yielded priority research areas for each of the seven GeoHealth Hub countries including heavy metal and pesticide contamination, tick-borne diseases, rabies, brucellosis, and inadequate public health surveillance.

SUBMITTER: Coman A

PROVIDER: S-EPMC4828928 | biostudies-literature | 2015 Dec

REPOSITORIES: biostudies-literature

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An assessment of the occupational and environmental health needs in seven Southeastern European and West-Central Asian countries.

Coman Alexandru A Cherecheş Răzvan M RM Ungureanu Marius I MI Marton-Vasarhelyi Emanuela O EO Valentine Marissa A MA Sabo-Attwood Tara T Gray Gregory C GC

Journal of epidemiology and global health 20150508 4

Eastern European and Central Asian countries are undergoing rapid socioeconomic and political reforms. Many old industrial facilities are either abandoned, or use outdated technologies that severely impact the environment. Emerging industries have less regulation than in developed countries and environmental and occupational problems seem to be increasing. Under a US National Institutes of Health pilot grant, we developed an interdisciplinary One Health research network in Southeastern Europe an ...[more]

PMID: 25963604

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Project description:BackgroundEastern Europe and Central Asia (EECA) is one of the regions where the HIV epidemic continues to grow at a concerning rate. Antiretroviral therapy (ART) coverage in EECA countries has significantly increased during the last decade, which can lead to an increase in the risk of emergence, transmission, and spread of HIV variants with drug resistance (DR) that cannot be controlled. Because HIV genotyping cannot be performed in these countries, data about HIV DR are limited or unavailable.ObjectivesTo monitor circulating HIV-1 genetic variants, assess the prevalence of HIV DR among patients starting antiretroviral therapy, and reveal potential transmission clusters among patients in six EECA countries: Armenia, Azerbaijan, Belarus, Russia, Tajikistan, and Uzbekistan.Materials and methodsWe analyzed 1071 HIV-1 pol-gene fragment sequences (2253-3369 bp) from patients who were initiating or reinitiating first-line ART in six EECA counties, i.e., Armenia (n = 120), Azerbaijan (n = 96), Belarus (n = 158), Russia (n = 465), Tajikistan (n = 54), and Uzbekistan (n = 178), between 2017 and 2019. HIV Pretreatment DR (PDR) and drug resistance mutation (DRM) prevalence was estimated using the Stanford HIV Resistance Database. The PDR level was interpreted according to the WHO standard PDR survey protocols. HIV-1 subtypes were determined using the Stanford HIV Resistance Database and subsequently confirmed by phylogenetic analysis. Transmission clusters were determined using Cluster Picker.ResultsAnalyses of HIV subtypes showed that EECA, in general, has the same HIV genetic variants of sub-subtype A6, CRF63_02A1, and subtype B, with different frequencies and representation for each country. The prevalence of PDR to any drug class was 2.8% in Uzbekistan, 4.2% in Azerbaijan, 4.5% in Russia, 9.2% in Armenia, 13.9% in Belarus, and 16.7% in Tajikistan. PDR to protease inhibitors (PIs) was not detected in any country. PDR to nucleoside reverse-transcriptase inhibitors (NRTIs) was not detected among patients in Azerbaijan, and was relatively low in other countries, with the highest prevalence in Tajikistan (5.6%). The prevalence of PDR to nonnucleoside reverse-transcriptase inhibitors (NNRTIs) was the lowest in Uzbekistan (2.8%) and reached 11.1% and 11.4% in Tajikistan and Belarus, respectively. Genetic transmission network analyses identified 226/1071 (21.1%) linked individuals, forming 93 transmission clusters mainly containing two or three sequences. We found that the time since HIV diagnosis in clustered patients was significantly shorter than that in unclustered patients (1.26 years vs 2.74 years). Additionally, the K103N/S mutation was mainly observed in clustered sequences (6.2% vs 2.8%).ConclusionsOur study demonstrated different PDR prevalence rates and DR dynamics in six EECA countries, with worrying levels of PDR in Tajikistan and Belarus, where prevalence exceeded the 10% threshold recommended by the WHO for immediate public health action. Because DR testing for clinical purposes is not common in EECA, it is currently extremely important to conduct surveillance of HIV DR in EECA due to the increased ART coverage in this region.

Project description:BackgroundIn Europe, mortality rates from noncommunicable diseases (NCDs) among persons 30-69 years of age ("NCD premature mortality rates") have declined significantly, except in twelve countries of Eastern Europe and Central Asia, namely Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia, Tajikistan, Turkmenistan, Ukraine and Uzbekistan. Data on long-term trends in NCD mortality in these countries are limited. We analyzed NCD premature mortality rates, identified change points in NCD mortality trends and forecasted how likely countries are to achieve the global NCD targets, stratified by gender and NCD type.MethodsWe used the 1990-2019 Global Burden of Disease database to analyze NCD trends and identified country-specific change points by using piecewise linear regression. We assessed the likelihood of achieving the global targets for reducing NCD premature mortality rates among persons 30-69 years of age from four NCDs: cancers, diabetes, cardiovascular and chronic respiratory diseases. The global NCD targets are 25% reduction in mortality from 2010 to 2025 (WHO 25X25 target) and 33%-from 2015 to 2030 (SDG 3.4.1). We applied the analysis to both genders and four NCDs.ResultsOnly Kazakhstan and Russia are likely to achieve the global NCD targets. For Kazakhstan, WHO 25X25 and SDG 3.4.1 global targets for mortality rates were 494.3 and 374.8 per 100,000 population respectively; the corresponding predicted values (PVs) were 360.6 [CI 260.1-461.1] and 245.1 [CI 113.4-376.8]. For Russia, WHO 25X25 and SDG 3.4.1 global targets were 560.5 and 442.8 per 100,000 population respectively; the corresponding PVs were 427.7 [CI 270.3-585.1] and 311.0 [CI 102.8-519.1]. Achieving NCD global targets is less likely for Kyrgyzstan, while it is unlikely for the rest of countries. Most countries had higher mortality rates and slower progress among men compared with women. The likelihood of achieving overall global NCD targets was mainly explained by reduction in cardiovascular mortality.ConclusionsIn most Eastern Europe and Central Asia countries, progress towards achieving NCD global targets is slow, or there's a reverse trend. Further quantitative and qualitative research is needed to understand the underlying reasons. Separate indicators are needed to monitor trends for cancers, diabetes and chronic respiratory diseases.

Project description:ObjectiveThis study explored and compared stakeholder perspectives on enhancements to cervical cancer screening for vulnerable women across seven European countries.DesignIn a series of Collaborative User Boards, stakeholders were invited to collaborate on identifying facilitators to improve cervical cancer screening.SettingThis study was part of the CBIG-SCREEN project which is funded by the European Union and targets disparities in cervical cancer screening for vulnerable women (www.cbig-screen.eu). Data collection took place in Bulgaria, Denmark, Estonia, France, Italy, Portugal and Romania.ParticipantsRepresented stakeholders at various levels, including user representatives (vulnerable women), healthcare professionals, social workers, programme managers and decision makers.Methods14 meetings lasting 2 hours each were held in these seven countries between October 2021 and June 2022. The meetings were audio or video recorded, transcribed and translated into English for qualitative framework analysis.ResultsWe engaged 120 participants in the Collaborative User Boards. Proposed solutions targeted both provider and system levels. In all countries, fostering trusting relationships between vulnerable women and social or healthcare professionals, coupled with community outreach for awareness and access to testing was a consistent recommendation. Participants in Estonia, Denmark, France, Italy, Portugal and Romania advocated for tailoring healthcare services to meet the unique needs of vulnerable populations through a holistic approach. In Bulgaria and Romania, participants advocated for the need to secure free access, from screening to follow-up, and emphasised the need for organised screening with target population screening registries.ConclusionThe study offers insights into stakeholders' recommendations for enhancing cervical cancer screening services for vulnerable women across seven European countries. Despite variations in the implementation level of population-based screening programmes, the imperative to optimise outreach and proximity work to improve cervical cancer screening resonated across all countries.

Project description:IntroductionEconomic evaluations of tobacco control policies targeting adolescents are scarce. Few take into account real-world, large-scale implementation costs; few compare cost-effectiveness of different policies across different countries. We assessed the cost-effectiveness of five tobacco control policies (nonschool bans, including bans on sales to minors, bans on smoking in public places, bans on advertising at points-of-sale, school smoke-free bans, and school education programs), implemented in 2016 in Finland, Ireland, the Netherlands, Belgium, Germany, Italy, and Portugal.MethodsCost-effectiveness estimates were calculated per country and per policy, from the State perspective. Costs were collected by combining quantitative questionnaires with semi-structured interviews on how policies were implemented in each setting, in real practice. Short-term effectiveness was based on the literature, and long-term effectiveness was modeled using the DYNAMO-HIA tool. Discount rates of 3.5% were used for costs and effectiveness. Sensitivity analyses considered 1%-50% short-term effectiveness estimates, highest cost estimates, and undiscounted effectiveness.FindingsNonschool bans cost up to €253.23 per healthy life year, school smoking bans up to €91.87 per healthy life year, and school education programs up to €481.35 per healthy life year. Cost-effectiveness depended on the costs of implementation, short-term effectiveness, initial smoking rates, dimension of the target population, and weight of smoking in overall mortality and morbidity.ConclusionsAll five policies were highly cost-effective in all countries according to the World Health Organization thresholds for public health interventions. Cost-effectiveness was preserved even when using the highest costs and most conservative effectiveness estimates.ImplicationsEconomic evaluations using real-world data on tobacco control policies implemented at a large scale are scarce, especially considering nonschool bans targeting adolescents. We assessed the cost-effectiveness of five tobacco control policies implemented in 2016 in Finland, Ireland, the Netherlands, Belgium, Germany, Italy, and Portugal. This study shows that all five policies were highly cost-effective considering the World Health Organization threshold, even when considering the highest costs and most conservative effectiveness estimates.

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An assessment of the occupational and environmental health needs in seven Southeastern European and West-Central Asian countries.

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An assessment of the occupational and environmental health needs in seven Southeastern European and West-Central Asian countries.

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