Life expectancy in Central and Eastern European countries and newly independent states of the former Soviet Union: changes by gender. (1/25)

AIM: To examine changes in life expectancy at birth for countries in Central and Eastern Europe (CEE) and the Newly Independent States of the former Soviet Union (NIS) for the period 1989-1996. Differences in the change by gender were examined and several factors which likely bear on the changes were discussed. Methods. Data from the WHO Health for All European Data Base were used to determine changes in life expectancy and selected economic factors for CEE and NIS countries. RESULTS: Changes in life expectancy varied by gender in both CEE and the NIS, with the difference increasing for the two groups during the period with the largest increase occurring in the NIS. Both male and female life expectancy declined, with male life expectancy dropping at a more rapid rate. In 1994, the year in which most, but not all countries, reached a low point, life expectancy for males had declined below 60 years for two countries. CONCLUSIONS: The most striking point about the decline in life expectancies was the short period in which the declines occurred, especially in the NIS. It is not possible to determine the exact cause for the changes, but there are likely multiple reasons. It is not completely clear why the decline in life expectancy was greater for males, although the linkage between economic and behavioral and lifestyle factors appear to have some association. Further research is necessary to determine why effects by gender vary so greatly and whether the negative outcomes are a short-term anomaly or will persist.  (+info)

Occupational cancer in the European part of the Commonwealth of Independent States. (2/25)

Precise information on the number of workers currently exposed to carcinogens in the Commonwealth of Independent States (CIS) is lacking. However, the large number of workers employed in high-risk industries such as the chemical and metal industries suggests that the number of workers potentially exposed to carcinogens may be large. In the CIS, women account for almost 50% of the industrial work force. Although no precise data are available on the number of cancers caused by occupational exposures, indirect evidence suggests that the magnitude of the problem is comparable to that observed in Western Europe, representing some 20,000 cases per year. The large number of women employed in the past and at present in industries that create potential exposure to carcinogens is a special characteristic of the CIS. In recent years an increasing amount of high-quality research has been conducted on occupational cancer in the CIS; there is, however, room for further improvement. International training programs should be established, and funds from international research and development programs should be devoted to this area. In recent years, following privatization of many large-scale industries, access to employment and exposure data is becoming increasingly difficult.  (+info)

The changing epidemiology of diphtheria in the vaccine era. (3/25)

The epidemic of diphtheria in the Newly Independent States (NIS) of the former Soviet Union has drawn attention to our incomplete understanding of the epidemiology of diphtheria. Many unanswered questions remain concerning the reasons for a resurgence of diphtheria and for the shift in the age of patients and concerning the mechanisms for acquisition of immunity in adults through natural infection under unfavorable living conditions. Other unanswered questions relate to the precise role of socioeconomic factors and hygiene conditions in the initiation, buildup, and spread of the epidemic. Important characteristics of the NIS epidemic can be used to help predict the spread of future diphtheria epidemics. These characteristics include a high proportion of infected adults, a progressive spread of disease from urban centers to rural areas, and transition from initial amplification of disease in groups with high rates of close contacts in focalized, well-distinguished outbreaks to a more generalized epidemic.  (+info)

Successful control of epidemic diphtheria in the states of the Former Union of Soviet Socialist Republics: lessons learned. (4/25)

Epidemic diphtheria reemerged in the Russian Federation in 1990 and spread to all Newly Independent States (NIS) and Baltic States by the end of 1994. Factors contributing to the epidemic included increased susceptibility of both children and adults, socioeconomic instability, population movement, deteriorating health infrastructure, initial shortages of vaccine, and delays in implementing control measures. In 1995, aggressive control strategies were implemented, and since then, all affected countries have reported decreases of diphtheria; however, continued efforts by national health authorities and international assistance are still needed. The legacy of this epidemic includes a reexamination of the global diphtheria control strategy, new laboratory techniques for diphtheria diagnosis and analysis, and a model for future public health emergencies in the successful collaboration of multiple international partners. The reemergence of diphtheria warns of an immediate threat of other epidemics in the NIS and Baltic States and a longer-term potential for the reemergence of vaccine-preventable diseases elsewhere. Continued investment in improved vaccines, control strategies, training, and laboratory techniques is needed.  (+info)

Diphtheria surveillance and control in the Former Soviet Union and the Newly Independent States. (5/25)

The Newly Independent States (NIS) inherited a common approach to diphtheria control from the Soviet Union and maintained a centralized system of surveillance and control managed by Soviet-trained epidemiologists with a shared professional culture. This system had controlled a diphtheria resurgence in the 1980s. In response to the epidemic of the 1990s, NIS health authorities responded with a set of control measures based on the Soviet-era experience. These measures included intensified childhood vaccination, aggressive case investigation, widespread diphtheria screening in institutions, and vaccination of adults in high-risk occupation groups. These measures proved insufficient due to high levels of susceptibility among adults, excessive contraindications to childhood vaccination, and insufficient resources in many countries. After these initial delays in implementing effective measures in some countries, most of the NIS health authorities rapidly and successfully implemented mass immunization of the population against diphtheria once the strategy was adopted and sufficient vaccine was available.  (+info)

Immunogenicity of tetanus-diphtheria toxoids (Td) among Ukrainian adults: implications for diphtheria control in the Newly Independent States of the Former Soviet Union. (6/25)

After 30 years of control, epidemic diphtheria returned to the Soviet Union in 1990. To develop control strategies, the immunogenicity of the tetanus and diphtheria toxoids (Td) vaccine was assessed. Workers who were 18-67 years old received two Td immunizations separated by 30 days. A neutralization assay determined diphtheria antitoxin (DAT) on enrollment and on days 7, 30, 60, and 425. On enrollment, 43.0% of 488 workers had DAT <0.1 IU/mL. After one dose, 88.5% had DAT >/=0.1 IU/mL, after two doses, 92.2% had >/=0.1 IU/mL and >90% of participants <30 or >/=50 years of age attained >/=1.0 IU/mL; however, only 78.4% of those who were 30-39 years old and 51.8% of those who were 40-49 years old achieved >/=1.0 IU/mL after two doses. To control the epidemic in Ukraine, one Td dose should be administered to virtually the entire population (persons 30-49 years old require three doses of Td for optimal individual protection and to maximize population immunity).  (+info)

Epidemic diphtheria in the Newly Independent States of the Former Soviet Union: implications for diphtheria control in the United States. (7/25)

The re-emergence of diphtheria in the Newly Independent States of the former Soviet Union in the 1990s raised global awareness of the potential for resurgent disease in countries with long-standing immunization programs. In the United States, the large population of susceptible adults and the possibility of a reintroduction of toxigenic strains of diphtheria create a setting in which diphtheria could spread. In addition, at least one focus of continued circulation of endemic toxigenic Corynebacterium diphtheriae has been identified. Few physicians now have expertise in the diagnosis and treatment of persons with diphtheria, and laboratory capacity is lacking throughout the country. These concerns highlight the importance of maintaining high levels of age-appropriate diphtheria toxoid vaccination, surveillance, accessible and reliable laboratory testing, and training of health care providers. Although the risk of resurgence of diphtheria in the United States is low, public health authorities must ensure that the capacity to recognize, diagnose, and control diphtheria is maintained.  (+info)

Implications of the diphtheria epidemic in the Former Soviet Union for immunization programs. (8/25)

The massive diphtheria epidemic in the former Soviet Union provides important lessons for all diphtheria immunization programs: It is important to achieve a high level of childhood immunization, maintain immunity against diphtheria in older age groups, and use anti-epidemic measures, including immunization, to control epidemics in the early phase. The immunization coverage among children should be at least 90%. Further studies are needed to elaborate the most effective strategy to maintain immunity against diphtheria in adults (periodic booster doses, immunization of selected age groups in health care settings, use of Td [tetanus-diphtheria toxoids with reduced diphtheria toxoid content] vaccine instead of monovalent tetanus toxoid whenever tetanus toxoid is indicated [e.g., in treatment of wounds or in school-based immunization programs]). Efforts should be undertaken to monitor diphtheria immunity in different groups by conducting age-specific serologic studies.  (+info)