Personality characteristics of physicians and end-of-life decisions in Russia.
(73/960)
OBJECTIVE: To explore the relationships between personality characteristics, underlying attitudes, and treatment decisions for severely ill elderly patients in a sample of Russian doctors. DESIGN: Survey. SETTING: Group sessions during meetings or individual presentations of questionnaire. SUBJECTS: A convenience sample of 231 physicians from the Archangelsk region in northern Russia who frequently encounter treatment situations with incompetent elderly patients. MEASUREMENTS: Temperament and Character Inventory (Cloninger et al, 1994) for assessing personality dimensions. The questionnaire on decision-making is based on the original developed by Molloy and coworkers from McMaster University in Canada. In a case-vignette, the condition of an 82-year-old man with acute gastrointestinal bleeding is described comprehensively in combination with 3 different levels of information about the patient wishes (no information, DNR order, advance directive). Questions about importance of legal concerns, patient and family wishes, hospital costs, patient's age and level of dementia, and physician's religion for the doctor's decision-making are added. MAIN RESULTS: No significant relationship was found between chosen treatment options and personality traits in any of the 3 situations. However, personality characteristics such as self-directedness, cooperativeness, and self-transcendence, in particular, show significant relationships with attitudes underlying these decisions. CONCLUSIONS: Physicians should be trained to improve their cooperative abilities in the treatment of severely ill elderly patients to be better prepared for their decision-making and coping concerning end-of-life decisions and the use of do-not-resuscitate orders and advance directives. Ethical values in clinical practice, especially patient autonomy, should be addressed during the early stage of the medical curriculum. (+info)
Russian-American partners for prevention. Adaptation of a school-based parent-child programme for alcohol use prevention.
(74/960)
BACKGROUND: The Russian-American Partners for Prevention was an adaptation and evaluation of the Slick Tracy Home Team Program which was developed in Minnesota in order to delay the onset of drinking. The Slick Tracy Home Team Program was the first intervention of Project Northland, a large 3 year community trial of the efficacy of a public health intervention for under age drinking. METHODS: The programme was administered through schools, but involved parents using engaging and fun homework activities. The Russian version was implemented in fifth-grade classrooms in 20 Moscow schools with 1,212 students surveyed at baseline. Students were surveyed again after programme implementation (n = 1,182), of whom 980 were present at baseline. Parents of 1,078 students were surveyed by telephone after programme implementation. RESULTS: The results demonstrated the successful recruitment and retention of 20 Moscow schools in a research project, acceptability of programme materials in Russia, high participation rates, changes in students' knowledge about problems associated with under age drinking and some evidence about increases in parent-child communication about alcohol use. As in the USA, no changes in students' alcohol use rates were observed at the end of the first year of the 3 year programme. CONCLUSION: Russian youth, as compared to Americans, began drinking at earlier ages, received fewer prevention messages from their parents, and had fewer prevention programmes in school. The results suggested that carefully implemented and evaluated replications of the US Project Northland interventions might provide effective and appropriate school-based programmes for Russia. (+info)
Hepatitis delta virus genotypes I and II cocirculate in an endemic area of Yakutia, Russia.
(75/960)
Currently, three genotypes of hepatitis delta virus (HDV) are described. The most common, genotype I, has a worldwide distribution; in contrast, genotype II has been found previously only in Japan and Taiwan, while genotype III is found exclusively in South America. Considering the high prevalence of HDV in Northern Siberia (Russia), restriction fragment length polymorphism (RFLP) was used to analyse HDV genotypes from 29 infected patients living in Yakutia. Of these isolates, 11 were characterized by partial nucleotide sequencing and two isolates were completely sequenced. Phylogenetic inference methods included maximum parsimony, maximum likelihood and distance analyses. A restriction pattern consistent with HDV genotype I was found in 14 samples, while the remaining 15 showed a different restriction pattern, inconsistent with any known genotype. Five Yakutian HDV isolates with the type I restriction pattern were sequenced and confirmed to be affiliated with genotype I, although the phylogenetic results indicate that they were heterogeneous and did not cluster together. Sequencing of eight isolates with the new RFLP pattern revealed that these isolates were most closely related to HDV genotype II. In contrast to HDV Yakutian genotype I sequences, all of these type II sequences formed a well-defined clade on phylogenetic trees. Comparison of clinical presentations during hospitalization between patients infected with HDV type I (n=14) and type II (n=15) did not reveal any differences in the severity of infection. These data indicate that the distribution of genotype II is not restricted to Taiwan or Japan, but spreads over Northern Asia, appearing in the native population of Yakutia. Type II Yakutian strains appeared to form a well-defined subclade and could be associated with severe chronic hepatitis in this area. (+info)
Risk behaviours and self rated health in Russia 1998.
(76/960)
OBJECTIVES: As self rated health and mortality represent different dimensions of public health and as risk behaviours have been closely related to mortality, we wanted to examine whether (poor) self rated health on the one hand and risk behaviours on the other can be attributed to different causes. METHODS: The Taganrog household survey (1998) was conducted in the form of face to face interviews and included 1009 people and their families. To estimate health differences and differences in risk behaviours between groups, logistic regressions were performed. RESULTS: In Taganrog between 1993/94 and 1998, changes in self rated health seem to have been much more dramatic than changes in smoking and different in direction from changes in heavy alcohol consumption. Moreover, self rated "poor" health was especially common among those whose economic situation was worse in 1998 than 10 years before. However, having a poorer economy during the period 1988-1998, does not seem to have affected drinking or smoking habits significantly. CONCLUSIONS: Self rated health seems to be closely related to three indicators of economic circumstances. Risk behaviours are probably important for the poor state of public health in Russia, but may be less sensitive to the economic aspects of the transition than is self rated health. (+info)
Cross-national comparison of childhood obesity: the epidemic and the relationship between obesity and socioeconomic status.
(77/960)
BACKGROUND: Obesity has become a worldwide epidemic. Recently WHO acknowledged an urgent need to examine child obesity across countries using a standardized international standard. Studies in adults find obesity and socioeconomic factors (SES) factors are correlated, but results are inconsistent for children. Using an international standard, we examined the prevalence of obesity and compared the associations between SES factors and obesity across countries. METHODS: Data for children aged 6-18 from nationwide surveys in the US (NHANES III, 1988-1994), China (1993), and Russia (1992) were used. We used the recently updated US NCHS body mass index (BMI = wt/ht(2)) reference to define obesity (BMI > or =95th percentile) and overweight (85th< or =BMI<95th percentile). The WHO recommends an early version of the NCHS reference for international use. We conducted logistic analyses to examine the relationship between SES and obesity. RESULTS: The prevalence of obesity and overweight was 11.1% and 14.3%, respectively, in the US, 6.0% and 10.0% in Russia, and 3.6% and 3.4% in China. The relationship between obesity and SES varied across countries. Higher SES subjects were more likely to be obese in China and Russia, but in the US low-SES groups were at a higher risk. Obesity was more prevalent in urban areas in China but in rural areas in Russia. CONCLUSIONS: Child obesity is becoming a public health problem worldwide, but the prevalence of obesity varies remarkably across countries with different socioeconomic development levels. Different SES groups are at different risks, and the relationship between obesity and SES varies across countries. (+info)
The angiotensin converting enzyme I/D polymorphism in Russian athletes.
(78/960)
The deletion (D) allele of the human ACE gene is associated with higher ACE activity than the insertion (I) allele. There is controversy as to whether the ACE genotype may be associated with elite athletic status; recent studies have identified no significant associations amongst those drawn from mixed sporting disciplines. However, such lack of association may reflect the mixed nature of such cohorts, given that an excess frequency of the I allele has been reported amongst elite endurance athletes, and an excess of the D allele amongst those engaged in more power-orientated sports. We examined this hypothesis by determining ACE I/D allele frequency amongst 217 Russian athletes (swimmers, skiers, triathletes and track-and-field participants) prospectively stratified by performance ('outstanding' or 'average'), and the duration of their event (SDA (<1 min), MDA (1 to 20 min), and LDA (>20 min): short, middle and long distance athletes respectively). ACE genotype and allele frequencies were compared to 449 controls. ACE genotype frequency amongst the whole cohort, or the outstanding athletes alone, was no different to that amongst sedentary controls. However, there was an excess of the D allele (frequency 0.72, P=0.001) amongst the outstanding SDA group, and an excess of the I allele (frequency 0.63, P=0.032) amongst the outstanding MDA group. These findings were replicated in the outstanding swimmers, with track and field SDA similarly demonstrating an excess of the D allele (P=0.01). There was no association found between the outstanding LDA and ACE genotype (P=0.27). These data not only confirm an excess of the D allele in elite SDA, and I allele in elite MDA, but also offer an explanation as to why any such association may be hard to detect amongst a heterogeneous cohort of mixed athletic ability and discipline. (+info)
Richness of Colchic vegetation: comparison between refugia of south-western and East Asia.
(79/960)
BACKGROUND: The Colchis is one of the species-rich refugia and a centre of biological diversity in western Eurasia. We analysed patterns of richness, endemism and invasions in relation to taxonomy (family membership), life form, certain habitats in the Colchis, and compared them to patterns found for Japan. RESULTS: We found that in the Colchis perennials are significantly over-represented in endemic species, and that they typically occur on limestone soils and in alpine tall herbaceous vegetation. The Asteraceae produce significantly large number of both endemic and alien species, whereas the Poaceae are over-represented in alien species but under-represented in endemics. Likewise, the Apiaceae are over-represented in endemics, whereas the Euphorbiaceae are over-represented in alien species. Similar patterns have been found in Yakushima, Japan. The Morisita-Horn index of similarity between these two sites was 0.83 (based on family size). Although the flora of Adjara comprised of fewer families than the flora of Yakushima, the largest families are richer in species in the flora of Adjara than in the flora of Yakushima. CONCLUSIONS: Floristic analysis of refugia of western Eurasia and their comparison with geographically distant areas can provide useful data for plant ecological and evolutionary studies. Potentially, such studies can produce testable hypotheses on plant migrations and on their historical geography. For example, the data presented in this study indicate that more severe conditions in the Pleistocene and geographical isolation of the Colchis may be responsible for the higher relative importance of adaptive radiation in the shaping of its modern flora. (+info)
Is the link between alcohol and cardiovascular death among young Russian men attributable to misclassification of acute alcohol intoxication? Evidence from the city of Izhevsk.
(80/960)
BACKGROUND: Research on the aetiology of sudden cardiac death among young men in Russia strongly suggests an association with binge drinking. However, the possibility remains that such deaths are misclassified as being attributable to cardiovascular disease when they are really caused by acute alcohol poisoning. OBJECTIVE: To describe postmortem levels of blood alcohol in Russian men dying from various causes and so determine whether deaths from alcohol poisoning are being misclassified as cardiovascular deaths. SETTING: Ishevsk, capital of the Udmurt Republic, situated in the Ural region of the Russian Federation. METHODS: The study was part of a larger one on adult mortality. The study sample was 309 deaths among men aged 20-55 dying between August 1998 and March 1999 from other than neoplasms, infectious diseases or unspecified causes and on whom necropsy records could be obtained. Information on cause of death was extracted from death certificates and data on postmortem blood alcohol concentration (BAC) from forensic records. Blood alcohol concentrations were adjusted where necessary to allow for delay in necropsy. RESULTS: Medium or greater levels of intoxication occurred in a quarter of those recorded as dying from cardiovascular disease but in over half of those dying from external causes. BAC levels consistent with at least strong intoxication were seen in 13.5% of deaths from cardiovascular disease and 27.1% from external causes. No cardiovascular deaths had BAC at levels usually thought to be fatal while this level was seen in 26% of deaths from accidental poisoning. CONCLUSION: Evidence of recent consumption of alcohol is common among Russian men dying under the age of 55, with severe intoxication common where death is from external causes. However, the high death rates from cardiovascular disease in Russia cannot be explained by misclassification of deaths attributable to acute alcohol poisoning. This study thus resolves one of the outstanding controversies in the story of alcohol and cardiovascular disease in the former Soviet Union. (+info)