The Impact of the Financial Crisis on Population Health and Health Systems

The Financial Crisis of 2008 had a profound impact on the economy of many European countries. The aims of this thesis are: to assess the consequences of the crisis for population health; to assess the impact of the crisis on health systems and identify responses that help countries to maintain stability and promote resilience. The financial crisis in Europe has posed major threats to health, but also some opportunities. It did not affect European countri

Amenable mortality in the EU-has the crisis changed its course?

Background: Did the global financial crisis and its aftermath impact upon the performance of health systems in Europe? We investigated trends in amenable and other mortality in the EU since 2000 across 28 EU countries. Methods: We use WHO detailed mortality files from 28 EU countries to calculate age-standardized deaths rates from amenable and other causes. We then use joinpoint regression to analyse trends in mortality before and after the onset of the economic crisis in Europe in 2008. Results: Amenable and other mortality have declined in the EU since 2000, albeit faster for amenable mortality. We observed increases in amenable mortality following the global financial crisis for females in Estonia [from -4.53 annual percentage change (APC) in 2005-12 to 0.03 APC in 2012-14] and Slovenia (from -4.22 APC in 2000-13 to 0.73 in 2013-15) as well as males and females in Greece(males: from -2.93 APC in 2000-10 to 0.01 APC in 2010-13; females: from -3.48 APC in 2000-10 to 0.06 APC in 2010-13). Other mortality continued to decline for these populations. Increases in deaths from infectious diseases before and after the crisis played a substantial part in reversals in Estonia, Slovenia and Greece. Conclusion: There is evidence that amenable mortality rose in Greece and, among females in Estonia and Slovenia. However, in most countries, trends in amenable mortality rates appeared to be unaffected by the crisis

The rise of mortality from mental and neurological diseases in Europe, 1979-2009: Observational study

Background: We studied recent trends in mortality from seven mental and neurological conditions and their determinants in 41 European countries. Methods. Age-standardized mortality rates were analysed using standard methods of descriptive epidemiology, and were related to cultural, economic and health care indicators using regression analysis. Results: Rising mortality from mental and neurological conditions is seen in most European countries, and is mainly due to rising mortality from dementias. Mortality from psychoactive substance use and Parkinson's disease has also risen in several countries. Mortality from dementias has risen particularly strongly in Finland, Iceland, Malta, Netherlands, Spain, Sweden and the United Kingdom, and is positively associated with self-expression values, average income, health care expenditure and life expectancy, but only the first has an independent effect. Conclusions: Although trends in mortality from dementias have probably been affected by changes in cause-of-death classification, the high level of mortality from these conditions in a number of vanguard countries suggests that it is now among the most frequent causes of death in high-income countries. Recognition of dementias as a cause of death, and/or refraining from life-saving treatment for patients with dementia, appear to be strongly dependent on cultural values

Health and health systems in the Commonwealth of Independent States.

The countries of the Commonwealth of Independent States differ substantially in their post-Soviet economic development but face many of the same challenges to health and health systems. Life expectancies dropped steeply in the 1990s, and several countries have yet to recover the levels noted before the dissolution of the Soviet Union. Cardiovascular disease is a much bigger killer in the Commonwealth of Independent States than in western Europe because of hazardous alcohol consumption and high smoking rates in men, the breakdown of social safety nets, rising social inequality, and inadequate health services. These former Soviet countries have embarked on reforms to their health systems, often aiming to strengthen primary care, scale back hospital capacities, reform mechanisms for paying providers and pooling funds, and address the overall shortage of public funding for health. However, major challenges remain, such as frequent private out-of-pocket payments for health care and underdeveloped systems for improvement of quality of care

On stability and performance of highly c-oriented columnar AlPO4-5 and CoAPO-5 membranes

[EN] Continuous films comprised of highly c-oriented aluminophosphate AlPO4-5 or cobalt-substituted AlPO4-5 (CoAPO-5) were grown on porous supports and subjected to heat treatment in order to investigate the potential for membrane applications. A study in the early stages of in-plane crystalline intergrowth revealed a potential mechanism for flake-like crystal formation between the original oriented columnar crystals. Variations in metal substitution (AlPO4-5, CoAPO-5), support (glass, silicon, porous alumina), and calcination method (conventional, rapid thermal processing) were chosen to examine the conditions by which structural integrity was compromised following secondary (or tertiary) growth, resulting in reduced membrane functionality. Through the use of rapid thermal processing, the structure debilitation could be partially avoided. The membrane quality was inspected through pervaporation measurements consisting of a liquid hydrocarbon feed of n-heptane and 1,3,5-triisopropylbenzene. By investigating the effect of template removal on the oriented, columnar crystalline structure, useful insight is provided into the potential for the membranes to participate in applications such as molecular separations, catalysis, or host-guest assemblies. (C) 2011 Elsevier Inc. All rights reserved.Support by the American Chemical Society (ACS-PRF) and the European Community through the FP7 NextGTL project and a Marie Curie International Reintegration Grant (FP7, Grant agreement No. 210947) is greatly appreciated. M.P. thanks CSIC for a JAE doctoral fellowship. We would like to thank Kumar Varoon for assistance with membrane sectioning and imaging using the focused ion beam technique. Parts of this work were carried out in the Characterization Facility on the campus of the University of Minnesota-Twin Cities, which receives partial support from NSF through the MRSEC program.Stoeger, JA.; Veziri, CM.; Palomino Roca, M.; Corma Canós, A.; Kanellopoulos, NK.; Tsapatsis, M.; Karanikolos, GN. (2012). On stability and performance of highly c-oriented columnar AlPO4-5 and CoAPO-5 membranes. Microporous and Mesoporous Materials. 147(1):286-294. https://doi.org/10.1016/j.micromeso.2011.06.028286294147

A systematic review on health resilience to economic crises

Background The health effects of recent economic crises differ markedly by population group. The objective of this systematic review is to examine evidence from longitudinal studies on factors influencing resilience for any health outcome or health behaviour among the general population living in countries exposed to financial crises. Methods We systematically reviewed studies from six electronic databases (EMBASE, Global Health, MEDLINE, PsycINFO, Scopus, Web of Science) which used quantitative longitudinal study designs and included: (i) exposure to an economic crisis; (ii) changes in health outcomes/behaviours over time; (iii) statistical tests of associations of health risk and/or protective factors with health outcomes/behaviours. The quality of the selected studies was appraised using the Quality Assessment Tool for Quantitative Studies. PRISMA reporting guidelines were followed. Results From 14,584 retrieved records, 22 studies met the eligibility criteria. These studies were conducted across 10 countries in Asia, Europe and North America over the past two decades. Ten socio-demographic factors that increased or protected against health risk were identified: gender, age, education, marital status, household size, employment/occupation, income/ financial constraints, personal beliefs, health status, area of residence, and social relations. These studies addressed physical health, mortality, suicide and suicide attempts, mental health, and health behaviours. Women’s mental health appeared more susceptible to crises than men’s. Lower income levels were associated with greater increases in cardiovascular disease, mortality and worse mental health. Employment status was associated with changes in mental health. Associations with age, marital status, and education were less consistent, although higher education was associated with healthier behaviours. Conclusions Despite widespread rhetoric about the importance of resilience, there was a dearth of studies which operationalised resilience factors. Future conceptual and empirical research is needed to develop the epidemiology of resilience

Investigating the impact of poverty on colonization and infection with drug-resistant organisms in humans: a systematic review

Background Poverty increases the risk of contracting infectious diseases and therefore exposure to antibiotics. Yet there is lacking evidence on the relationship between income and non-income dimensions of poverty and antimicrobial resistance. Investigating such relationship would strengthen antimicrobial stewardship interventions. Methods A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Ovid, MEDLINE, EMBASE, Scopus, CINAHL, PsychINFO, EBSCO, HMIC, and Web of Science databases were searched in October 2016. Prospective and retrospective studies reporting on income or non-income dimensions of poverty and their influence on colonisation or infection with antimicrobial-resistant organisms were retrieved. Study quality was assessed with the Integrated quality criteria for review of multiple study designs (ICROMS) tool. Results Nineteen articles were reviewed. Crowding and homelessness were associated with antimicrobial resistance in community and hospital patients. In high-income countries, low income was associated with Streptococcus pneumoniae and Acinetobacter baumannii resistance and a seven-fold higher infection rate. In low-income countries the findings on this relation were contradictory. Lack of education was linked to resistant S. pneumoniae and Escherichia coli. Two papers explored the relation between water and sanitation and antimicrobial resistance in low-income settings. Conclusions Despite methodological limitations, the results suggest that addressing social determinants of poverty worldwide remains a crucial yet neglected step towards preventing antimicrobial resistance