Deindustrialization and the Postsocialist Mortality Crisis

An unprecedented mortality crisis struck Eastern Europe during the transition from socialism to capitalism. Working-class men without a college degree suffered the most. Some argue that economic dislocation caused stress and despair, leading to adverse health behavior and ill health (dislocation-despair approach). Others suggest that hazardous drinking inherited as part of a dysfunctional working-class culture and populist alcohol policy were the key determinants (supply-culture approach). We enter this debate by performing the first quantitative analysis of the association between economic dislocation in the form of industrial employment decline and mortality in postsocialist Eastern Europe. We rely on a novel multilevel dataset, fitting survival and panel models covering 52 towns and 42,800 people in 1989-1995 in Hungary and 514 medium-sized towns in the European part of Russia. The results show that deindustrialization was significantly associated with male mortality in both countries directly and indirectly mediated by adverse health behavior as a dysfunctional coping strategy. Both countries experienced severe deindustrialization, but social and economic policies seem to have offset Hungary’s more immense industrial employment loss. The policy implication is that social and economic policies addressing the underlying causes of stress and despair can improve health

Intergenerational mobility in relative educational attainment and health-related behaviours

Research on intergenerational social mobility and health-related behaviours yields mixed findings. Depending on the direction of mobility and the type of mechanisms involved, we can expect positive or negative association between intergenerational mobility and health-related behaviours. Using data from a retrospective cohort study, conducted in more than 100 towns across Belarus, Hungary and Russia, we fit multilevel mixed-effects Poisson regressions with two measures of health-related behaviours: binge drinking and smoking. The main explanatory variable, intergenerational educational mobility is operationalised in terms of relative intergenerational educational trajectories based on the prevalence of specified qualifications in parental and offspring generations. In each country the associations between intergenerational educational mobility, binge drinking and smoking was examined with incidence rate ratios and predicted probabilities, using multiply imputed dataset for missing data and controlling for important confounders of health-related behaviours. We find that intergenerational mobility in relative educational attainment has varying association with binge drinking and smoking and the strength and direction of these effects depend on the country of analysis, the mode of mobility, the gender of respondents and the type of health-related behaviour. Along with accumulation and Falling from Grace hypotheses of the consequences of intergenerational mobility, our findings suggest that upward educational mobility in certain instances might be linked to improved health-related behaviours

Acute subglottic laryngitis. Etiology, epidemiology, pathogenesis and clinical picture

In about 3% of children, viral infections of the airways that develop in early childhood lead to narrowing of the laryngeal lumen in the subglottic region resulting in symptoms such as hoarseness, a barking cough, stridor, and dyspnea. These infections may eventually cause respiratory failure. The disease is often called acute subglottic laryngitis (ASL). Terms such as pseudocroup, croup syndrome, acute obstructive laryngitis and spasmodic croup are used interchangeably when referencing this disease. Although the differential diagnosis should include other rare diseases such as epiglottitis, diphtheria, fibrinous laryngitis and  bacterial tracheobronchitis, the diagnosis of ASL should always be made on the basis of clinical criteria

The management of COVID-19 cases through telemedicine in Brazil.

In Dec 2020 Brazil became one of the worldwide epicenters of the COVID-19 pandemic with more than 7.2M reported cases. Brazil has a large territory with unequal distribution of healthcare resources including physicians. Resource limitation has been one of the main factors hampering Brazil's response to the COVID-19 crisis. Telemedicine has been an effective approach for COVID-19 management as it allows to reduce the risk of cross-contamination and provides support to remote rural locations. Here we present the analyses of teleconsultations from a countrywide telemedicine service (TelessáudeRS-UFRGS, TRS), that provides physician-to-physician remote support during the COVID-19 pandemic in Brazil. We performed a descriptive analysis of the teleconsultation incoming calls and a text analysis from the call transcripts. Our findings indicate that TRS teleconsultations in Brazil experienced an exponential increment of 802.% during a period of 6 days, after the first death due to COVID-19 was reported. However, the number of teleconsultations cases decreased over time, despite the number of reported COVID-19 cases continuously increasing. The results also showed that physicians in low-income municipalities, based on GDP per capita, are less likely to consult the telemedicine service despite facing higher rates of COVID-19 cases. The text analysis of call transcripts from medical teleconsultations showed that the main concern of physicians were "asymptomatic" patients. We suggest an immediate reinforcement of telehealth services in the regions of lower income as a strategy to support COVID-19 management

The management of COVID-19 cases through telemedicine in Brazil

In Dec 2020 Brazil became one of the worldwide epicenters of the COVID-19 pandemic with more than 7.2M reported cases. Brazil has a large territory with unequal distribution of healthcare resources including physicians. Resource limitation has been one of the main factors hampering Brazil’s response to the COVID-19 crisis. Telemedicine has been an effective approach for COVID-19 management as it allows to reduce the risk of cross-contamination and provides support to remote rural locations. Here we present the analyses of teleconsultations from a countrywide telemedicine service (Telessa´udeRS-UFRGS, TRS), that provides physician-to-physician remote support during the COVID-19 pandemic in Brazil. We performed a descriptive analysis of the teleconsultation incoming calls and a text analysis from the call transcripts. Our findings indicate that TRS teleconsultations in Brazil experienced an exponential increment of 802.% during a period of 6 days, after the first death due to COVID-19 was reported. However, the number of teleconsultations cases decreased over time, despite the number of reported COVID-19 cases continuously increasing. The results also showed that physicians in low-income municipalities, based on GDP per capita, are less likely to consult the telemedicine service despite facing higher rates of COVID-19 cases. The text analysis of call transcripts from medical teleconsultations showed that the main concern of physicians were “asymptomatic” patients. We suggest an immediate reinforcement of telehealth services in the regions of lower income as a strategy to support COVID-19 management.Telemedicin

Recommendations for the management of tuberculosis in children — KOMPASS TB. Part 1: Tuberculosis prevention

Since the second half of the 20th century the incidence of tuberculosis has been declining in Poland. Despite this, current epidemiological data still support the need for the continued mass BCG vaccination in Poland in the near future. Apart from the protection against severe hematogenous forms of tuberculosis, vaccination lowers the risk of infection with Mycobacterium tuberculosis. Primary and acquired immunodeficiency, including immunity disorders associated with an ongoing treatment, are contraindications to BCG vaccination. The most common adverse effects following BCG vaccination are reactions at the site of injection and in regional lymph nodes, which usually does not require treatment. Methods of tuberculosis prevention, particularly recommended in low-incidence countries, include: diagnostic investigations of patients who had contacts with pulmonary tuberculosis as well as an active detection and treatment of latent Mycobacterium tuberculosis infection. Latent tuberculosis infection can be identified on the basis of positive results of the tuberculin skin test or interferon-gamma release assays after the active disease has been ruled out. This condition does require prophylactic treatment

Mortality in Transition: Study Protocol of the PrivMort Project, a multilevel convenience cohort study.

BACKGROUND: Previous research using routine data identified rapid mass privatisation as an important driver of mortality crisis following the collapse of Communism in Central and Eastern Europe. However, existing studies on the mortality crisis relying on individual level or routine data cannot assess both distal (societal) and proximal (individual) causes of mortality simultaneously. The aim of the PrivMort Project is to overcome these limitations and to investigate the role of societal factors (particularly rapid mass privatisation) and individual-level factors (e.g. alcohol consumption) in the mortality changes in post-communist countries. METHODS: The PrivMort conducts large-sample surveys in Russia, Belarus and Hungary. The approach is unique in comparing towns that have undergone rapid privatisation of their key industrial enterprises with those that experienced more gradual forms of privatisation, employing a multi-level retrospective cohort design that combines data on the industrial characteristics of the towns, socio-economic descriptions of the communities, settlement-level data, individual socio-economic characteristics, and individuals' health behaviour. It then incorporates data on mortality of different types of relatives of survey respondents, employing a retrospective demographic approach, which enables linkage of historical patterns of mortality to exposures, based on experiences of family members. By May 2016, 63,073 respondents provided information on themselves and 205,607 relatives, of whom 102,971 had died. The settlement-level dataset contains information on 539 settlements and 12,082 enterprises in these settlements in Russia, 96 settlements and 271 enterprises in Belarus, and 52 settlement and 148 enterprises in Hungary. DISCUSSION: In addition to reinforcing existing evidence linking smoking, hazardous drinking and unemployment to mortality, the PrivMort dataset will investigate the variation in transition experiences for individual respondents and their families across settlements characterized by differing contextual factors, including industrial characteristics, simultaneously providing information about how excess mortality is distributed across settlements with various privatization strategies.The study was funded by European Research Council (a competitive externally peer reviewed Advanced Grant Scheme, grant agreement No. 269036).This is the final version of the article. It first appeared from BioMed Central at http://dx.doi.org/10.1186/s12889-016-3249-

Rekomendacje postępowania w gruźlicy u dzieci — KOMPAS TB. Część 1 — profilaktyka gruźlicy

Od drugiej połowy XX wieku obserwuje się w Polsce systematyczny spadek liczby zachorowań na gruźlicę. Mimo to aktualne wskaźniki epidemiologiczne uzasadniają kontynuację powszechnych szczepień BCG w naszym kraju w najbliższych latach. Poza ochroną przed ciężkimi, krwiopochodnymi postaciami gruźlicy, szczepienie to zmniejsza ryzyko zakażenia prątkiem gruźlicy. Przeciwwskazania do szczepienia BCG to między innymi pierwotne i nabyte niedobory odporności, w tym zaburzenia immunologiczne związane ze stosowanym leczeniem. Do najczęstszych niepożądanych odczynów po szczepieniu BCG należą zmiany w miejscu szczepienia i zmiany odczynowe w lokalnych węzłach chłonnych, zazwyczaj niewymagające leczenia. Metody zapobiegania gruźlicy, szczególnie zalecane w krajach o niskiej zapadalności na tę chorobę, to: diagnostyka osób stykających się z chorym na gruźlicę płuc oraz aktywne wykrywanie i leczenie utajonego zakażenia prątkiem gruźlicy. Utajone zakażenie prątkiem gruźlicy rozpoznaje się na podstawie dodatnich wyników odczynu tuberkulinowego (OT) lub testu wydzielania interferonu gamma, po wykluczeniu gruźlicy aktywnej. Stan ten wymaga leczenia profilaktycznego.Od drugiej połowy XX wieku obserwuje się w Polsce systematyczny spadek liczby zachorowań na gruźlicę. Mimo to aktualne wskaźniki epidemiologiczne uzasadniają kontynuację powszechnych szczepień BCG w naszym kraju w najbliższych latach. Poza ochroną przed ciężkimi, krwiopochodnymi postaciami gruźlicy, szczepienie to zmniejsza ryzyko zakażenia prątkiem gruźlicy. Przeciwwskazania do szczepienia BCG to między innymi pierwotne i nabyte niedobory odporności, w tym zaburzenia immunologiczne związane ze stosowanym leczeniem. Do najczęstszych niepożądanych odczynów po szczepieniu BCG należą zmiany w miejscu szczepienia i zmiany odczynowe w lokalnych węzłach chłonnych, zazwyczaj niewymagające leczenia. Metody zapobiegania gruźlicy, szczególnie zalecane w krajach o niskiej zapadalności na tę chorobę, to: diagnostyka osób stykających się z chorym na gruźlicę płuc oraz aktywne wykrywanie i leczenie utajonego zakażenia prątkiem gruźlicy. Utajone zakażenie prątkiem gruźlicy rozpoznaje się na podstawie dodatnich wyników odczynu tuberkulinowego (OT) lub testu wydzielania interferonu gamma, po wykluczeniu gruźlicy aktywnej. Stan ten wymaga leczenia profilaktycznego

Cultural Determinants of Global Health

This PhD thesis examines the role of cultural values as a predictor of population health and wellbeing in a global context. Within the Social Determinants of Health (SDH) framework, several factors including social class, income and education have been studied extensively as drivers of cross-national differences in health, but much less literature exists on the role of culture and cultural values. In order to address this gap in the literature I employ a qualitative analytical approach applied to multiple waves of the World Values Survey (1979-2014). In an initial analysis, I assess whether the three most common cultural values models, those of Hofstede, Schwartz and Inglehart, are good predictors of population health outcomes. Indulgence, traditional/rational, intellectual and affective autonomy, long-term orientation and embeddedness dimensions yield largest effect sizes in predicting health outcomes. I also find a significant and large interaction effects between country’s wealth and selected cultural dimensions Secondly, I develop a novel, data-driven, computationally intensive approach to Exploratory Factor Analysis to explore whether clusters, or dimensions, of values exist, and which are the most relevant for explaining population health. Of the dimensions identified, I find that religiosity, membership in civic organisations and democratic views are the most useful for explaining global differences in health and wellbeing. Thirdly, I explore the question of autonomy. I show that two dimensions of autonomy may be identified, which I term Individual and Female Autonomy. Of the two, Individual Autonomy is a good predictor of rates of national maternal mortality and combined maternal and child mortality. Finally, I critically review and assess country-level indicators of women’s social position (also referred to in the literature as gender equality or equity, or women’s empowerment). I provide an extensive critique of the so-called ‘parity’ approach prevalent in the global health and development literature, and suggest an alternative ‘institutional’ approach as more comprehensive and socially just

Frustration as the factor affecting empathy.

The presented work is the attempt to answer the question about the impact of frustration on the level of empathy. The study conducted took the form of a two-stage experiment in which 120 students of the Jagiellonian University attended, of the first and fourth year, studying in various fields. For measurement of empathy the two tools were used: the so-called Stories Questionnaire, constructed by the author, and The Interpersonal Reactiviy Index (IRI) created by Mark H. Davis (Davis, 1980, 1983). In the first part of the experiment participants were asked to answer the questions in both questionnaires examining empathy, and resolve the tasks to measure intelligence. In the second part of the experiment the false intelligence test results were presented to them and they were asked to fill empathy supplement questionnaires again. False test results constituted experimental manipulation applied to induce a sense of frustration of the individuals being examined. Feedback Low result obtained by a person in a test of intelligence was a frustrating factor. Feedback about obtaining a high intelligence test result was the so-called factor of success.The following research hypotheses were set: 1) the frustration factor results in low levels of empathy with the subjects of the examination, as measured by the Questionnaire and the questionnaire IRI stories, 2) the success factor increases the level of empathy with the subjects of examination, as measured by the Questionnaire stories and IRI questionnaire, 3 ) there are cross-sex differences in the output level of empathy and 4) there are cross-sex differences in the dynamics of empathy changes caused by feedback from intelligence test obtained in the test result among the participating students in the experiment.The following research hypotheses were set: 1) the frustration factor results in low levels of empathy with the subjects of the examination, as measured by the Questionnaire and the questionnaire IRI stories, 2) the success factor increases the level of empathy with the subjects of examination, as measured by the Questionnaire stories and IRI questionnaire, 3 ) there are cross-sex differences in the output level of empathy and 4) there are cross-sex differences in the dynamics of empathy changes caused by feedback from intelligence test obtained in the test result among the participating students in the experiment.Main hypothesis was confirmed. There was found small but significant decrease of empathy among individuals who received negative feedback in the second part of empathy research. There were not observed significant changes in the level of empathy among those who were exposed to the factor of success. Also it failed to demonstrate cross-sex differences in the output level of empathy, as well as differences in the dynamics of changes in empathy as a result of frustration or the response factor of success. This result, however, might be explained by the relatively small number of people participating in both parts of the study, and not the actual lack of cross-sex differences in empathy.The study therefore showed that the experience of frustration affects negatively the level of empathy. The observed decline in empathy was not however big, what may mean that experienced frustration at the moment is one of the many factors determining the level of empathy in humans.Prezentowana praca stanowi próbę odpowiedzi na pytanie o wpływ frustracji na poziom empatii. Przeprowadzone przeze autorkę badanie miało formę dwustopniowego eksperymentu, w którym wzięło udział 120 studentów Uniwersytetu Jagiellońskiego, pierwszego i czwartego roku, studiujących na różnych kierunkach. Do pomiaru empatii użyto dwóch narzędzi: skonstruowanego przeze autorkę tzw. Kwestionariusza Historyjek, oraz The Interpersonal Reactiviy Index, w skrócie IRI autorstwa Marka H. Davisa (Davis, 1980, 1983). W pierwszej części badania uczestnicy proszeni byli o udzielenie odpowiedzi na pytania zawarte w obu kwestionariuszach badających empatię, a także rozwiązanie zadań służących do pomiaru inteligencji. W drugiej części badania przedstawiono im fałszywe wyniki testu inteligencji, a także poproszono o ponowne uzupełnienie kwestionariuszy badających empatię. Fałszywe wyniki testu inteligencji stanowiły manipulacje eksperymentalną zastosowaną w celu wywołania poczucia frustracji u badanych. Informacja zwrotna o niskim wyniku uzyskanym przez daną osobę w teście inteligencji stanowiła czynnik frustrujący. Informacja zwrotna o uzyskaniu wysokiego wyniku w teście inteligencji stanowiła natomiast tzw. czynnik sukcesu. W pracy postawiono następujące hipotezy badawcze: 1) czynnik frustracji powoduje obniżenie poziomu empatii u osób badanych, mierzonego za pomocą Kwestionariusza Historyjek oraz kwestionariusza IRI, 2) czynnik sukcesu powoduje wzrost poziomu empatii u osób badanych, mierzonego za pomocą Kwestionariusza Historyjek oraz kwestionariusza IRI, 3) istnieją różnice międzypłciowe w wyjściowym poziomie empatii oraz 4) istnieją różnice międzypłciowe w dynamice zmian poziomu empatii wywołanych przez informację zwrotną na temat uzyskanego w teście inteligencji wyniku wśród biorących udział w eksperymencie studentów. Hipoteza główna została potwierdzona. U osób, które otrzymały negatywną informację zwrotną odnotowano nieduży, ale znaczący spadek empatii w drugiej części badania. Nie zauważono natomiast istotnych zmian w poziomie empatii u osób, które poddano działaniu czynnika sukcesu. Nie udało się też udowodnić różnic międzypłciowych w wyjściowym poziomie empatii, a także różnic w dynamice zmian empatii na skutek zadziałania czynnika frustracji bądź sukcesu. Wynik ten tłumaczę jednak stosunkowo niewielką liczbą mężczyzn biorących udział w obu częściach badania, a nie faktycznym brakiem występowania różnic międzypłciowych w zakresie empatii. Badanie wykazało zatem, iż doświadczenie frustracji wpływa ujemnie na poziom empatii. Zaobserwowany spadek empatii nie był jednak duży co oznaczać może, iż doznawana chwilowo frustracja jest jednym z bardzo wielu czynników warunkujących poziom stanu empatii u człowieka