Громадське здоров'я у світі, що швидко змінюється

Several months in 2013 and 2014 have been a hardly predictable time in Ukraine, and the situation is still far from being stable. This made the editorial team of TCPHEE based in Ukraine postpone publishing consecutive issues. However, while the situation still requires practical steps, many aspects including those related to public health require analysis and debate. Thus we invite opinion pieces and studies addressing all different spheres of how public health should function under changing social circumstances. There might be a wide range of such related topics.The most obvious ones are those linked to changing living conditions. Many studies have been undertaken and published with regard to health threats to refugees, people involved in natural or technical disasters (Noji, 2005). Along with environmental health threats, there might be mental health disturbances (World Health Organization, 1992) resulting from long-term strain, losses et cetera.Another important focus is related to changes in health services provision. Crimea, which is a former Ukrainian territory now occupied by the Russian Federation, was among those in Ukraine highly affected with HIV (Dehne, Khodakevich, Hamers, & Schwartlander, 1999). This was responded by several NGOs actively providing harm reduction services to high-risk groups along with methadone substitution therapy to opiate users and antiretroviral medicines to those HIV-infected (Curtis, 2010). However, there are news reports that Russia is going to stop provision of methadone (kommersant.ru, 2014). As opiate substitution programs have been shown an effective approach towards preventing HIV transmission among people who inject drugs (MacArthur et al., 2012), such change in public health policies might affect not only most at risk populations but their partners and population as a whole as well resulting in a rapid spread of HIV.Yet another related topic is that of how health services can be organized at times of social upheavals. Health service of Maidan, though has already attracted much attention (Yasynska, February 7, 2014), should probably become a focus of more scrutiny as an example of volunteer labor force and resources involvement.However, a wide range of even more difficult issues is to be addressed once life comes to some order after the power transfer to those people who were in favor of the changes. Some models have long been known and just required practical implementation - including those related to preventive medicine and primary health care, to mention just two established internationally as a must of health care several decades ago but still not fully in place in Ukraine. Nevertheless, as these models could not be properly implemented for many years in line, this might derive from the obstacles pertaining to either how health workers are educated or how the system is regulated.Considering the best intentions of people who aimed, as opposed to the bygone authorities, to work for the benefit of their compatriots, we may assume that they would be willing to implement the ideas and technologies with proven ability to improve health and well-being of people. Yet, implementation of evidence-based approaches might be deemed slow and boring in comparison to heroic happenings and populist slogans of the power transfer. What are the tipping points to achieve changes in how people think and work in order to open doors for the best practices elaborated elsewhere along with trial-based implementation of new ideas arising on the spot? Though diffusion of innovation (Rogers, 1962) is a well-known model that describes the process, what could be made to facilitate it?If evidence-based and benefit-aimed technologies are to be brought into deployment, obviously good surveillance systems (Klaucke et al., 1988) become inexorably needed. Yet, overall they are costly and difficult to justify in a poor country. What is an appropriate way of their step by step implementation which allows quick display of payoffs and cost-effective use with the impact on the ways people think and act?Yet, the opposite side of the same story, those pieces of surveillance which are already in place are very unlikely to be properly used. Even those favorable trends in national statistics which showed years of declining mortality (Polischuk, Krasovsky, & Andreeva, 2009) and could be presented by ruling politicians as a sign of their successes, is neglected. This certainly does not mean that surveillance is not needed, but this is still the need to be felt and the tool to be understood and learnt.Many models considered normal and well-developed within the public health in the West are still beyond proper understanding of most health professionals in Ukraine, and probably other countries which resemble it in some features. An important achievement of Maidan was the feeling of community, the ability to self-organize in order to solve arising issues. While 'community' was a hardly definable entity in most countries deriving from the former Soviet Union, it now becomes tangible how people can be together and act together. This gives opportunities to address issues of 'community health,' which was never perceived a realistic construct before. How communities live and act, how they might interact with health policies and health determinants at different levels, how to diagnose and understand them is still another large area that was never studied or taught in a country we come from.Moving towards Europe, as Ukraine strives now, requires crucial changes in many spheres of life. What are the known rules for these changes to happen? What are the hypothetical predictors of these changes to be successful? What are the additional factors yet to be explored and taken into account? Your knowledge, ideas and guesses are welcome

The value of personal credit history in risk screening of entrepreneurs:Evidence from marketplace lending

We explore the quality of risk assessment for entrepreneurs/small business borrowers as compared to consumers, when the same information on previous credit history is used for both segments in marketplace lending. By building several cross-sectional logistic regression and machine-learning models and applying them separately to small business loans (SBL) and consumers we can measure models’ predictive accuracy for different segments, and thus, make observations about the value of the information used for screening. We find the differences in profiles between SBL and consumers, hence they should be assessed by separate models. Yet separate SBL models do not perform well when applied to a future time period. We attribute this to the relatively low predictive value of personal credit history for entrepreneurs as compared to the consumers. We advocate the use of additional information for risk assessment of entrepreneurs, in order to improve the quality of credit screening. This should lead to improved access of small business borrowers to credit in situations when they have to compete with consumers for funding

Socio-economic determinants of eating practices of Ukrainians

BACKGROUND: Healthy eating practices are among important public health goals worldwide. We aimed to investigate socio-economic determinants of the nutrition habits of Ukrainian families. METHODS: Data from the “Ukrainian Longitudinal Monitoring Survey 2007” were analysed. Factor analysis produced variables characterising eating practices, which were re-coded in binary variables indicating low/high food consumption. The bivariate and multivariate analysis was conducted to identify associations between socio-economic state and eating modes. RESULTS: Three dimensions of nutrition practices were identified in the factor analysis: “standard diet” variable associated with quantities of most food products consumed, it actually shows how much food in general the household consumes, “fruit-and-vegetable diet” variable was associated with quantities of various fruits and vegetables included in the questionnaire, and “processed-(pre-packed)-food diet” variable was created based on its associations with products like sausage. More “processed” food was consumed by members of households which were generally better-off (equipped with dvd-player, computer (laptop), garage), and Russian-speakers. More plant food was consumed by the households with attributes of rural living (equipped with bottled gas, central or individual system of heating, those who possessed a motorcycle or a truck). The owners of a plot adjacent to rural house or land used for gardening were eating more fruit and vegetables. A small group of well-off urban dwellers (like those possessing tumble-dryers) tend to eat more plant food; however, this group is not numerous. CONCLUSION: Plant food eating in Ukraine stays a factor of survival rather than healthy eating for those households which dwell in rural areas and have no means to choose foods they want. Those people who achieve better socio-economic status tend to increase processed food portion of their diets. Only a very small group of affluent Ukrainian citizens tend to eat much fruit and vegetables contributing to U-form relationship between socio-economic status and antioxidant-rich food consumption. KEYWORDS: eating practices, socio-economic characteristics

Characteristics associated with being overweight among the population of Ukraine, results of 2000 survey

BACKGROUND. Being overweight is considered among major risk factors of chronic non-communicable diseases. The goal of this study was to investigate main determinants associated with being overweight and obese among the population of Ukraine in transitional period. METHODS. Data from the survey “Health and Well-being in the Transitions” (2000) were used. Body mass index (BMI) was used to estimate the level of overweight. Binary dependent variable was computed by setting BMI of 25 as the borderline between normal weight and overweight. Risk of being overweight was compared by educational groups, demographic characteristics, occupation, level of physical activity, and behavioral and eating habits, after adjustment for age and stratification by gender. RESULTS. Among men, those overweight were less likely to smoke (adjusted odds ratio 2,5), while more likely to eat meat more often (AOR=2,3) and to consume more vegetable oil. However, among women being overweight was associated with eating more potatoes (AOR = 0,4) and with frequent vodka intake (AOR = 1,7). Those women who drank beer were less likely to be overweight (AOR = 0,3). Risk of being overweight was related to occupation: those unemployed, housekeepers, and self-employed people were less likely to be overweight than those employed with salaries. Obesity risk was greater in those older than 30. Education and physical activity did not show significant associations with risk of being overweight. CONCLUSION. Eating habits, occupational status, and unhealthy habits were associated with obesity among men and women in different ways. Age was found to be an important factor of being overweight both for males and females. Some of the associated characteristics may be considered causes of being overweight and the others as consequences

Legislative background of food and nutrition policy in Ukraine

BACKGROUND: The importance of effective policy aimed at improving nutrition practices is highly recognized by the global community. METHODS: Analysis of Ukrainian legislative documents was conducted to clarify the situation in the field of policy initiatives and legislation devoted to nutrition in Ukraine. Documents in force adopted from 1991 to 2011 including key words “nutrition”, “health”, “concept”, and “food products” were reviewed. RESULTS: We reviewed 55 legislative acts related to nutrition and identified several groups: 18 documents are related to organization of supply, regimen, norms of nutrition in state establishments or for special populations; 12 documents related to economic and technological regulation of food preparation, quality control and distribution; 3 documents regulating nutritious and safety norms of food products for children under 3 years; 14 documents aimed to control food safety, quality and accessibility; 6 other documents partly referred to nutrition, including 4 Concepts of healthy lifestyles. Some of the principles of healthy eating are declared in the “Concept of improving food security and quality of nutrition of the population” approved by the Cabinet of Ministers in 2004. Principles of maintaining breastfeeding, activities aimed to reduce iodine deficiency among population as well as school educational program “Foundations of health” were those few governmental activities, which supported some of the ideas declared in the Concept. CONCLUSION: Great attention of policymakers is paid to regulation of production, distribution of food, its quality control, affordability of products for special population groups, especially children. Not much attention is devoted in the official documents to creating and maintaining the healthy eating practices of the population. Mechanisms aimed to form healthy eating practices are not specified in the legislative documents. No regulatory documents to implement these principles were found. The existing regulatory documents do not fully reflect global trends and practices for healthy eating. KEYWORDS: healthy eating, nutrition policy

Поведінкові кореляти надмірної ваги і ожиріння серед населення України

BACKGROUND: Overweight and obesity are among the greatest health challenges nowadays. This study aimed to investigate correlates of overweight among the population ofUkraine.METHODS: Data from the survey “Health and Well-Being in Transition Societies” (2000) were analyzed. Body mass index (BMI) based on self-reported height and weight was used to estimate the extent of overweight both in continuous and dichotomous form. Binary dependent variable was computed by setting BMI of 25 as the borderline between normal weight and overweight. Education, demographic characteristics, field of activity, level of physical activity, behavioral and eating habits were considered as independent variables.RESULTS: In 2000, 44% of Ukrainian population (39% of men and 49% of women) were overweight. Risk of overweight increased with age: among those below 40 years old, 16% of men and 12% of women were overweight, about 47% of men and 60% of women were overweight in 40+ groups. Among young men (under 40), those consuming more fruit (OR=0,31) and more physically active (OR=0,43) were less likely to be overweight. In women over 60, those overweight were more physically active (OR=2,32). In men over 40 and women below 40, prevalence of overweight was lower in smokers than in non-smokers. Eating potatoes, meat and milk was associated with increased BMI in some groups. No consistent associations were found for consumption of fish, butter, oil, sugar, and vegetables, as well as for education.CONCLUSION: In 2000, Ukrainian population did not bear patterns of obesity epidemics found in the West: no associations with either socioeconomic status or foods usually associated with overweight were found. Overweight was more likely related to increased use of traditional foods like dairy products, meat and potatoes. Smoking was related to lower BMI in populations with high prevalence of smoking.АКТУАЛЬНОСТЬ: Избыточный вес (ИВ) и ожирение является одной из наиболее серьезных проблем для здоровья. Цель нашего исследования заключалась в определении поведенческих коррелят ИВ среди населения Украины.МЕТОДЫ: Проанализированы данные опроса "Здоровье и благополучие в переходных обществах" (2000). Для оценки степени избыточности массы тела использовался индекс массы тела (ИМТ), рассчитанный с использованием сообщенных респондентами массы и роста. Данные проанализированы методами логистической регрессии и генерализованной линейной модели (GLM). Бинарная зависимая переменная сформирована путем установления ИМТ=25 в качестве границы между ИВ и нормальным весом. Независимыми переменными являлись уровень образования, демографические характеристики, сфера деятельности, уровень физической активности, поведенческие и пищевые привычки.РЕЗУЛЬТАТЫ: В 2000 году у 44% населения Украины (39% мужчин и 49% женщин) был ИВ. Риск ожирения увеличивается с возрастом: среди респондентов моложе 40 лет, 16% мужчин и 12% женщин имели ИВ, в то время как в группе 40 + ИВ присущ около 47% мужчин и 60% женщин. Среди молодых мужчин (до 40 лет) те, кто употребляет больше фруктов (OR = 0,31) и физически активны (OR = 0,43), были менее склонны к ИВ. Среди женщин старше 60 лет имеющие ИВ чаще занимались физическими упражнениями (OR = 2,32). Распространенность ИВ среди мужчин старше 40 лет и женщин моложе 40, которые курят, была ниже, чем среди тех, кто не употребляет табак. Для употребляющих картофель, мясо и молоко характерен повышенный ИМТ. Не было обнаружено устойчивых ассоциаций для потребления рыбы, сливочного и растительного масла, сахара, овощей, а также для уровня образования.ЗАКЛЮЧЕНИЕ: В 2000 году в Украине не было обнаружено основных коррелят возникновения ИВ, характерных для стран Запада: не было найдено ассоциации с социально-экономическим статусом или употреблением продуктов, как правило, связанных с избыточным весом. ИВ был с большей вероятностью связан с частым употреблением «традиционных» продуктов питания, таких как молочные продукты, мясо и картофель. Курение связано с низким ИМТ в группах населения с высокой распространенностью курения.АКТУАЛЬНІСТЬ: Надмірна вага (НВ) і ожиріння є однією з найбільш серйозних проблем для здоров'я. Це дослідження мало на меті визначити поведінкові кореляти НВ серед населення України.МЕТОДИ: Проаналізовано дані опитування "Здоров'я та благополуччя в перехідних суспільствах" (2000). Для оцінки ступеня надлишкової маси тіла використано індекс маси тіла (ІМТ), розрахований з використанням даних респондентів щодо ваги і зросту. Дані проаналізовано методами логістичної регресії та генералізованої лінійної моделі (GLM). Бінарну залежну змінну обчислено шляхом встановлення ІМТ = 25 як межу між нормальною вагою та НВ. Основними незалежними змінними були рівень освіти респондентів, демографічні характеристики, сфера діяльності, рівень фізичної активності, поведінкові і харчові звички.РЕЗУЛЬТАТИ: У 2000 році 44 % населення України (39 % чоловіків і 49 % жінок) мали НВ. Ризик НВ збільшується з віком: серед респондентів молодше 40 років 16% чоловіків і 12% жінок мали НВ, у той час як у групі 40 + НВ була притаманна близько 47% чоловіків і 60% жінок. Серед молодих чоловіків (до 40 років) ті, хто споживає більше фруктів (OR = 0,31) і більш фізично активні (OR = 0,43), менш схильні до НВ. Жінки старше 60 років з НВ більш фізично активні (OR = 2,32). Поширеність НВ серед чоловіків старше 40 років і жінок молодше 40, які курять, була нижчою, ніж серед некурців. Вживання картоплі, м'яса і молока було пов'язано з підвищеним ІМТ в деяких групах. Не виявлено асоціацій для споживання риби, вершкового масла, олії, цукру, овочів, а також для рівня освіти.ВИСНОВОК: У 2000 році в Україні не було виявлено основних ризиків виникнення ожиріння, характерних для країн Заходу: не було знайдено асоціації з соціально-економічним статусом або вживанням продуктів, як правило, пов'язаних з надмірною вагою. НВ з більшою ймовірністю пов'язана з частим вживанням «традиційних» продуктів харчування, таких як молочні продукти, м'ясо і картопля. Куріння було пов'язано з низьким індексом маси тіла в групах населення з високою поширеністю куріння

Purification of washing waters of iron removal stations

The article presents the results on use of water preparation waste, namely the fulfilled ionites of KU-2-8 and AV-17-8 as a coagulant for purification of washing waters of iron removal stations. In this work the optimum dose of offered coagulants, degree of washing waters clarification, residual iron concentration in washing waters after 2 h of sedimentation were defined. Specific resistance to filtering of received deposit was also established. This deposit is suggested to be used for ceramic goods manufacture