Post-communist transition and health in Europe.
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ABSTRACT:
SUBMITTER: McKee M
PROVIDER: S-EPMC535436 | biostudies-literature | 2004 Dec
REPOSITORIES: biostudies-literature
Publications
Post-communist transition and health in Europe.
McKee Martin M Fister Kristina K
BMJ (Clinical research ed.) 20041201 7479
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Project description:ObjectiveWe aim to study the "golden youth" hypothesis, which suggests that risky behaviors might be prevalent among affluent adolescents in post-Communist countries of Europe (PCCE) with high income inequality.MethodsWe included 71,119 adolescents aged 11-15 from 14 PCCE participating in the Health Behavior in School-aged Children survey 2017/18. A K-means cluster analysis was conducted to group adolescents based on risky behavior. Generalized linear mixed models were fitted.ResultsThe proportion of high-SEP adolescents in Cluster 2, characterized by frequent alcohol consumption but moderate frequency of drunkenness, was greater than that of low-SEP adolescents (14.3 % vs. 10.7 %). The prevalence of risky behaviors was similar for high and low-SEP adolescents in Cluster 3 (high smoking, frequent alcohol use, drunkenness, and moderate bullying) (8.0 % vs. 8.2 %) and Cluster 4 (high bullying perpetration) (6.7 % vs. 7.2 %). Countries with higher Gini index were at greater risk of reporting risky behaviors. High-SEP adolescents were more likely to engage in risky behaviors in countries with high income inequality. The odds ratios comparing high- vs. low-SEP adolescents ranged from 0.89 in the least unequal to 1.67 in the most unequal countries for multiple risky behaviors (Cluster 3: P-interaction = 0.042) and from 0.61 to 1.19 for bullying perpetration (Cluster 4: P-interaction = 0.030).ConclusionsHigh-SEP adolescents in PCCE might be at increased risk for unhealthy and vicious behaviors, especially in countries with high income inequality. Redistributive policies decreasing the gap between rich and poor are needed to ensure the health and well-being of adolescents in PCCE.
| S-EPMC11406008 | biostudies-literature
Project description:BackgroundGeneral psychiatric and forensic psychiatric beds, supported housing and the prison population have been suggested as indicators of institutionalized mental health care. According to the Penrose hypothesis, decreasing psychiatric bed numbers may lead to increasing prison populations. The study aimed to assess indicators of institutionalized mental health care in post-communist countries during the two decades following the political change, and to explore whether the data are consistent with the Penrose hypothesis in that historical context.Methodology/principal findingsGeneral psychiatric and forensic psychiatric bed numbers, supported housing capacities and the prison population rates were collected in Azerbaijan, Belarus, Croatia, Czech Republic, East Germany, Hungary, Kazakhstan, Latvia, Poland, Romania, Russia and Slovenia. Percentage change of indicators over the decades 1989-1999, 1999-2009 and the whole period of 1989-2009 and correlations between changes of different indicators were calculated. Between 1989 and 2009, the number of general psychiatric beds was reduced in all countries. The decrease ranged from -11% in Croatia to -51% in East Germany. In 2009, the bed numbers per 100,000 population ranged from 44.7 in Azerbaijan to 134.4 in Latvia. Forensic psychiatric bed numbers and supported housing capacities increased in most countries. From 1989-2009, trends in the prison population ranged from a decrease of -58% in East Germany to an increase of 43% in Belarus and Poland. Trends in different indicators of institutionalised care did not show statistically significant associations.Conclusions/significanceAfter the political changes in 1989, post-communist countries experienced a substantial reduction in general psychiatric hospital beds, which in some countries may have partly been compensated by an increase in supported housing capacities and more forensic psychiatric beds. Changes in the prison population are inconsistent. The findings do not support the Penrose hypothesis in that historical context as a general rule for most of the countries.
| S-EPMC3371010 | biostudies-literature
Project description:BACKGROUND:Health of the population of post-socialist Central and Eastern European (CEE) countries lags behind the European Union average. Our aim in this paper is to analyse the link between transition shocks and health two-three decades later. METHODS:We use retrospective data from the Survey of Health, Ageing and Retirement in Europe. We estimate the implications of stressful periods, financial hardships and job loss occurring around the transition (1987-1993) on subjective and objective measures of health in 2017. We compare these implications across groups of CEE countries and with the health implications of similar difficulties reported by individuals from Western Europe. We also compare the health implications of difficulties occurring around the transition to difficulties occurring before or after the transition. RESULTS:In the CEE region there is a peak in the timing of difficulties around the transition. Stressful periods, financial difficulties and job loss around the period of transition are generally associated with worse subjective and objective health at older ages in all groups of CEE countries, even after netting out the effect of childhood health and demographic factors. However, the consequences of hardships due to the transition are not specific, health implications of these difficulties seem to be similar to the implications of other shocks possibly unrelated to the transition. CONCLUSIONS:The high fraction of individuals experiencing stress, financial difficulties and job loss around the transition contributed to the current health disadvantage in the CEE region. As similar shocks in the West and before or after the transition had similar health implications, our results draw the attention to the long-lasting impacts of psychosocial stress and financial hardship during adulthood on later health over the life course.
| S-EPMC7227088 | biostudies-literature
Project description:As of December 2021, all former Communist countries from Central and Eastern Europe were still lagging behind in terms of COVID-19 vaccination rates in Europe. Can institutional legacy explain, at least in part, this heterogeneity in vaccination decisions across Europe? To study this question we exploit novel data from the second wave of the SHARE (Survey of Health, Ageing and Retirement in Europe) COVID-19 Survey fielded in Summer (2021) that covers older individuals in 27 European countries. First, we document lower COVID-19 vaccine take-up amongst those who were born under Communism in Europe. Next, we turn to reunified Germany to get closer to a causal effect of having lived behind the Iron Curtain. We find that exposure to the Communist regime in East Germany decreased one's probability to get vaccinated against COVID-19 by 8 percentage points and increased that of refusing the vaccine by 4 percentage points. Both effects are large and statistically significant, and they hold when controlling for individual socio-economic and demographic characteristics. We explore several possible mechanisms. The East-West Germany gap does not seem to be explained by differences in the impact of the first wave of the pandemic or in general exposure to vaccines. We find that East Germans have lower social capital than West Germans and that social capital correlates negatively with Covid-10 vaccine uptake, but only a small fraction of the East-West Germany Covid-19 vaccination gap can be explained by our measures of social capital.
| S-EPMC9901226 | biostudies-literature
Project description:BackgroundPrevious studies have indicated that International Monetary Fund (IMF) economic programs have influenced health-care infrastructure in recipient countries. The post-communist Eastern European and former Soviet Union countries experienced relatively similar political and economic changes over the past two decades, and participated in IMF programs of varying size and duration. We empirically examine how IMF programs related to changes in tuberculosis incidence, prevalence, and mortality rates among these countries.Methods and findingsWe performed multivariate regression of two decades of tuberculosis incidence, prevalence, and mortality data against variables potentially influencing tuberculosis program outcomes in 21 post-communist countries for which comparative data are available. After correcting for confounding variables, as well as potential detection, selection, and ecological biases, we observed that participating in an IMF program was associated with increased tuberculosis incidence, prevalence, and mortality rates by 13.9%, 13.2%, and 16.6%, respectively. Each additional year of participation in an IMF program was associated with increased tuberculosis mortality rates by 4.1%, and each 1% increase in IMF lending was associated with increased tuberculosis mortality rates by 0.9%. On the other hand, we estimated a decrease in tuberculosis mortality rates of 30.7% (95% confidence interval, 18.3% to 49.5%) associated with exiting the IMF programs. IMF lending did not appear to be a response to worsened health outcomes; rather, it appeared to be a precipitant of such outcomes (Granger- and Sims-causality tests), even after controlling for potential political, socioeconomic, demographic, and health-related confounders. In contrast, non-IMF lending programs were connected with decreased tuberculosis mortality rates (-7.6%, 95% confidence interval, -1.0% to -14.1%). The associations observed between tuberculosis mortality and IMF programs were similar to those observed when evaluating the impact of IMF programs on tuberculosis incidence and prevalence. While IMF programs were connected with large reductions in generalized government expenditures, tuberculosis program coverage, and the number of physicians per capita, non-IMF lending programs were not significantly associated with these variables.ConclusionsIMF economic reform programs are associated with significantly worsened tuberculosis incidence, prevalence, and mortality rates in post-communist Eastern European and former Soviet countries, independent of other political, socioeconomic, demographic, and health changes in these countries. Future research should attempt to examine how IMF programs may have related to other non-tuberculosis-related health outcomes.
| S-EPMC2488179 | biostudies-literature
Project description:This article familiarizes readers with the international research project ‘The Missing Link: Exploring Organized Interests in Post-Communist Policy-Making’ (OrgIntCEE). The project team has focused on how populations of organized interests in the region have evolved, how they interact with state institutions as well as the group-specific characteristics driving access to policy-makers. The project also explores how Europeanization has affected post-communist interest groups as well as other factors contributing to their “coming-of-age.” We provide a comprehensive overview of the population ecology and survey datasets, while shedding light on the challenges during the data collection process. After a short overview of the project context and structure, we present some country-specific aggregated data on organizational densities and their political activity. We also reflect on potential uses for the data, before wrapping up the article with a self-critical assessment of what could have been done differently as a roadmap for future research. Supplementary Information The online version contains supplementary material available at 10.1057/s41309-022-00172-1.
| S-EPMC9665044 | biostudies-literature
Project description:We explore patterns and determinants of health transition probabilities by combining outcomes of morbidity and mortality to examine different aging patterns across Europe, and to ascertain how individual socio-demographic characteristics modify these patterns. We use panel data from the Survey of Health, Ageing and Retirement in Europe (2004- 2017) for 76,536 individuals aged 50 + in 20 European countries who participated in at least two waves. All transition probabilities were calculated applying a multistate analytical approach. Our findings show significant gender, education, and cohort differences in health transition probabilities and marked cross-country group differences. Central and Northern European countries present lower probabilities of health deterioration than Southern and, especially, Eastern European countries. Having a high level of education, living in Central Europe, and being younger are associated with lower probabilities of health deterioration and, if any, a higher probability of being restored to good health. We found less evidence of differences when transitions end in death. Our study contributes to this line of research by implementing a multistate approach using European harmonized panel dataset, to examine the effects of birth cohort, educational attainment and gender differences on health transitions. Our findings point to the need to consider the specific influence of individual factors in the aging process in different transitions according to the context and with reference to specific vulnerable groups. In the context of aging societies, such a consideration is both essential and policy relevant.Supplementary informationThe online version contains supplementary material available at 10.1007/s12062-022-09403-4.
| S-EPMC9702679 | biostudies-literature
Project description:Caesarean section rates are rising across Europe, and concerns exist that increases are not clinically indicated. Societal, cultural and health system factors have been identified as influential. Former communist (transition) countries have experienced radical changes in these potential determinants, and we, therefore, hypothesized they may exhibit differing trends to non-transition countries. By analysing data from the WHO Europe Health for All Database, we find transition countries had a relatively low caesarean section rate in 2000 but have since experienced more rapid increases than other countries (average annual percentage change 7.9 vs. 2.4).
| S-EPMC3662018 | biostudies-literature
Project description:Heart failure (HF) patients have high rates of hospitalization and rehospitalization.A protocol-driven clinic staffed by an allied health care team was designed for patients discharged from the hospital with a diagnosis of congestive HF. The clinic provided follow-up visits 1 week and 4 to 6 weeks after hospital discharge. One-hundred and fourteen patients were observed at least 1 time, and 80% of these patients completed the 2-visit protocol. Clinical evaluations were provided by a nurse practitioner specializing in HF and a clinical pharmacist; these evaluations included physical examination, laboratory evaluation, medical education and reconciliation, medication adjustment and titration, and care coordination. Referrals to home health and appropriate services were provided. At visit 1, 25% of patients were hypervolemic and 13% were hypovolemic. At visit 2, 20% were hypervolemic and 13% were hypovolemic. Medicine reconciliation errors were common, with an average of 2.1 and 0.8 errors per person recorded for visits 1 and 2, respectively. Clinic participants showed a 44.3% reduction in 30-day readmission rates, as compared to the hospital's average 30-day readmission rates.Protocol-driven postdischarge transition care delivered by allied health staff addressed multiple transition issues and was associated with a dramatic reduction in readmission rates.
| S-EPMC4845270 | biostudies-other