Traces of the Second Demographic Transition in Four Selected Countries in Central and Eastern Europe: Union Formation as a Demographic Manifestation.
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ABSTRACT:
SUBMITTER: Hoem JM
PROVIDER: S-EPMC2720586 | biostudies-other | 2009 Aug
REPOSITORIES: biostudies-other
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Project description:BackgroundAlmost 100 novel cancer medicines have been approved in Europe over the last decade. Limited public health care resources in countries in Central and Eastern Europe (CEE) call for a prioritization of access to effective medicines. We investigated how both reimbursement status and waiting time to reimbursement correlate with the magnitude of clinical benefit provided by novel medicines in four selected countries (Czechia, Hungary, Poland, and Slovakia).Materials and methodsA total of 124 indications of 51 cancer medicines with marketing authorization by the European Medicines Agency in 2011-2020 were included and followed up until 2022. Data on reimbursement status and waiting time to reimbursement (i.e. time from marketing authorization to national reimbursement approval) were collected for each country. Data were analyzed in relation to clinical benefit status (i.e. substantial versus nonsubstantial clinical benefit) of indications according to the European Society for Medical Oncology Magnitude of Clinical Benefit Scale (ESMO-MCBS).ResultsThe degree of reimbursement differed between countries with 64% of indications with reimbursement in Czechia, 40% in Hungary, 51% in Poland, and 19% in Slovakia. In all countries, a significantly greater proportion of indications with a substantial clinical benefit was reimbursed (P < 0.05). The median waiting time to reimbursement ranged from 27 months in Poland to 37 months in Hungary. No significant differences in waiting time in relation to clinical benefit were observed in any country (P = 0.25-0.84).ConclusionsCancer medicines with a substantial clinical benefit are more likely to be reimbursed in all four CEE countries. Waiting times to reimbursement are equally long for medicines with or without a substantial clinical benefit, indicating a lack of prioritization of fast access to medicines delivering a substantial benefit. Incorporation of the ESMO-MCBS in reimbursement assessments and decisions could aid in better utilization of limited resources to deliver more effective cancer care.
| S-EPMC10485399 | biostudies-literature
Project description:The article focuses on several demographic and socio-economic idiosyncrasies in Central and Eastern Europe, which impact the process of population ageing and intergenerational relations. These include the adverse mortality trends and especially the excess male mortality in certain countries, which exacerbated sex differences in life expectancy beyond anything ever recorded in peace-time population history, the combination of natural population decrease and net emigration, the disordered cohort flows and the shorter generational length. The rapid demographic change in these countries coincided with political, economic and social transformations. The shock of the fall of communism affected differently younger people, who could relatively easily reorganize their life cycles so as to adapt to the changed circumstances, and older persons for whom such reorganization was more difficult, or even impossible. This created the possibility for the opening of an intergenerational rift, as older generations felt being the losers of the transition. The article explores the implications of these idiosyncrasies and social context for living arrangements, kin networks, individual wellbeing and inter-generational relations, and identifies areas where particular challenges are likely to be faced when it comes to policies and programs aimed at older persons.
| S-EPMC5547418 | biostudies-other
Project description:AimsThe Systematic COronary Risk Evaluation (SCORE) scale assesses 10 year risk of fatal atherosclerotic cardiovascular disease (CVD), based on conventional risk factors. The high-risk SCORE version is recommended for Central and Eastern Europe and former Soviet Union (CEE/FSU), but its performance has never been systematically assessed in the region. We evaluated SCORE performance in two sets of population-based CEE/FSU cohorts.Methods and resultsThe cohorts based on the World Health Organization MONitoring of trends and determinants in CArdiovascular disease (MONICA) surveys in the Czech Republic, Poland (Warsaw and Tarnobrzeg), Lithuania (Kaunas), and Russia (Novosibirsk) were followed from the mid-1980s. The Health, Alcohol, and Psychosocial factors in Eastern Europe (HAPIEE) study follows Czech, Polish (Krakow), and Russian (Novosibirsk) cohorts from 2002-05. In Cox regression analyses, the high-risk SCORE ≥5% at baseline significantly predicted CVD mortality in both MONICA [n = 15 027; hazard ratios (HR), 1.7-6.3] and HAPIEE (n = 20 517; HR, 2.6-10.5) samples. While SCORE calibration was good in most MONICA samples (predicted and observed mortality were close), the risk was underestimated in Russia. In HAPIEE, the high-risk SCORE overpredicted the estimated 10 year mortality for Czech and Polish samples and adequately predicted it for Russia. SCORE discrimination was satisfactory in both MONICA and HAPIEE.ConclusionThe high-risk SCORE underestimated the fatal CVD risk in Russian MONICA but performed well in most MONICA samples and Russian HAPIEE. This SCORE version might overestimate the risk in contemporary Czech and Polish populations.
| S-EPMC3938861 | biostudies-literature
Project description:BackgroundThe European Commission requires tobacco products sold in the European Union to display standardized text health warnings. This article examines the effectiveness of the text health warnings among daily cigarette smokers in four Member States.MethodsData were drawn from nationally representative samples of smokers from the International Tobacco Control Policy Evaluation Project surveys in France (2007), Germany (2007), the Netherlands (2008) and the UK (2006). We examined: (i) smokers' ratings of the health warnings on warning salience, thoughts of harm and quitting and forgoing of cigarettes; (ii) impact of the warnings using a Labels Impact Index (LII), with higher scores signifying greater impact; and (iii) differences on the LII by demographic characteristics and smoking behaviour.ResultsScores on the LII differed significantly across countries. Scores were highest in France, lower in the UK, and lowest in Germany and the Netherlands. Across all countries, scores were significantly higher among low-income smokers, smokers who had made a quit attempt in the past year and smokers who smoked fewer cigarettes per day.ConclusionThe impact of the health warnings varies greatly across countries. Impact tended to be highest in countries with more comprehensive tobacco control programmes. Because the impact of the warnings was highest among smokers with the lowest socioeconomic status (SES), this research suggests that health warnings could be more effective among smokers from lower SES groups. Differences in warning label impact by SES should be further investigated.
| S-EPMC3457002 | biostudies-literature
Project description:BackgroundHealth research governance is an essential function of national health research systems. Yet many African countries have not developed strong health research governance structures and processes. This paper presents a comparative analysis of national health research governance in Botswana, Kenya, Uganda and Zambia, where health sciences research production is well established relative to some others in the region and continues to grow. The paper aims to examine progress made and challenges faced in strengthening health research governance in these countries.MethodsWe collected data through document review and key informant interviews with a total of 80 participants including decision-makers, researchers and funders across stakeholder institutions in the four countries. Data on health research governance were thematically coded for policies, legislation, regulation and institutions and analysed comparatively across the four national health research systems.ResultsAll countries were found to be moving from using a research governance framework set by national science, technology and innovation policies to one that is more anchored in health research structures and policies within the health sectors. Kenya and Zambia have adopted health research legislation and policies, while Botswana and Uganda are in the process of developing the same. National-level health research coordination and regulation is hampered by inadequate financial and human resource capacities, which present challenges for building strong health research governance institutions.ConclusionBuilding health research governance as a key pillar of national health research systems involves developing stronger governance institutions, strengthening health research legislation, increasing financing for governance processes and improving human resource capacity in health research governance and management.
| S-EPMC8513324 | biostudies-literature
Project description:The European Commission requested EFSA to estimate the risk of spread of African swine fever (ASF) and to identify potential risk factors (indicators) for the spread of ASF, given introduction in the south-eastern countries of Europe (region of concern, ROC), namely Albania, Bosnia and Herzegovina, Croatia, Greece, Kosovo, Montenegro, North Macedonia, Serbia and Slovenia. Three EU Member States (MS) - Croatia, Greece and Slovenia - were included in the ROC due to their geographical location and ASF-free status. Based on collected information on potential risk factors (indicators) for each country and the relevant EU regulations in force, the estimated probability of spread of ASF within the ROC within one year after introduction into the ROC was assessed to be very high (from 66% to 100%). This estimate was determined after considering the high number of indicators present in most of the countries in the ROC and the known effect that these indicators can have on ASF spread, especially those related to the structure of the domestic pig sector, the presence of wild boar and social factors. The presence of indicators varies between countries in the ROC. Each country is at risk of ASF spread following introduction; however, some countries may have a higher probability of ASF spread following introduction. In addition, the probability of ASF spread from the ROC to EU MSs outside the ROC within one year after introduction of ASF in the ROC was estimated to be very low to low (from 0% to 15%). This estimate was based on the comparison of the indicators present in the ROC and the already affected countries in south-eastern Europe, such as Bulgaria and Romania, where there was no evidence of ASF spread to other EU MS within one year.
| S-EPMC7008867 | biostudies-literature
Project description:BackgroundDevelopment assistance from governments of high income countries represents the vast majority of international funding for global health. Recent stagnation of this important source of funding may affect attainment of major global health goals. The financial crisis is widely accredited as denting governments' outlay for development aid, as well as citizen's support for aid. Europe has also recently experienced record levels of migration; the so called 'European migration crisis'. This study aims to analyse trends in public attitudes towards development aid in European Union (EU) countries, in the context of the European migrant crisis.MethodsEurobarometer survey data from 2011 (prior to the migrant crisis) and 2015 (at the peak of the crisis) was analysed for 27 EU countries. The outcome variables related to people's levels of support to three statements around the importance of supporting people in developing countries, increasing countries' commitments to aid and willingness to pay extra for products from developing countries. EU Member States were categorised as 'arrival' or 'destination' countries in view of migration routes and numbers of asylum applications per 100,000 population, respectively. Multiple linear regression analysis was performed, adjusting for countries' economic status (gross domestic product per capita).ResultsIn general, support for development aid has increased from 2011 to 2015, but was largely unaffected by migration status when applying the regression model. In 2015, the belief that development assistance is 'very important' was significantly higher in countries where migrants first arrived compared to other EU Member States, with a trend towards this association also apparent in 2011.ConclusionsThe positive trends in public support for development aid are encouraging in an age where economic hardships at home, as well as the tone of national political discourses and rising right wing populism appear to suggest otherwise.
| S-EPMC6022484 | biostudies-literature
Project description:In recent years, prices for veterinary care have received considerable attention in mainstream media, yet scientific literature has not delved into actual figures. This study aims to elucidate veterinary care costs for dogs, cats, and horses across five countries [Sweden (SE), Norway (NO), Denmark (DK), United Kingdom (UK), and Ireland (IR, with limited data)] through web searches. Utilising online business directories, we located URLs featuring veterinary care prices in autumn 2022, and repeated tri-monthly five times. Vetpris.se (VP), a price comparison site for SE, NO, and DK, emerged from the search. Additionally, we sought to compare price data from veterinary clinics (ranging from animal hospitals to small private clinics) using a similar approach to VP. We targeted elective procedures (e.g., gonadectomy, GDY) and common procedures (e.g., pyometra surgery in dogs). Comparing data from the same clinics' websites and from VP within extraction from autumn 2022 to winter 2023/2024, median prices for dog and cat GDY were largely consistent. By October 2023, median prices for male cat GDY ranged from €72 (SE) to €230 (DK), and €130 (SE) to €361 (DK) for females; for dog GDY from €390 (SE) to €599 (DK) for males, and €461 (UK) to €1015 (DK) for females. Across sources, median prices for cat and dog GDY increased by 2-24% over a year for procedures with at least 10 clinics per extraction. Equine GDY (per sedation and local analgaesia) in SE saw a 64% increase by year-end, with a median price of €492. Emergency surgeries during regular-hours (e.g., pyometra and caesarean section) in SE were approximately €2,300 at the last extraction, marking a 27% increase for pyometra surgery during regular-hours and 15% after-hours compared to the previous year. Variability existed within and across countries and diagnoses/procedures. Cross-validation suggested VP generally provided reliable information, though data points for emergencies were limited. Our web searching tool necessitated extensive manual verification, indicating room for further development. We recommend enhancing price transparency for animal owners to become better informed about the cost of veterinary care and be able to make informed choices.
| S-EPMC11292583 | biostudies-literature
Project description:BACKGROUND: Out-of-pocket payments for health services constitute a major financial burden for patients in Central and Eastern European (CEE) countries. Individuals who are unable to pay use different coping strategies (e.g. borrowing money or foregoing service utilization), which can have negative consequences on their health and social welfare. This article explores patients' inability to pay for outpatient and hospital services in six CEE countries: Bulgaria, Hungary, Lithuania, Poland, Romania and Ukraine. METHODS: The analysis is based on quantitative data collected in 2010 in nationally representative surveys. Two indicators of inability to pay were considered: the need to borrow money or sell assets and foregoing service utilization. Statistical analyses were applied to investigate associations between the indicators of inability to pay and individual characteristics. RESULTS: Patient payments are most common in Bulgaria, Ukraine, Romania and Lithuania and often include informal payments. Romanian and, particularly, Ukrainian patients most often face difficulties to pay for health services (with approximately 40% of Ukrainian payers borrowing money or selling assets to cover hospital payments and approximately 60% of respondents who need care foregoing services). Inability to pay mainly affects those with poor health and low incomes. CONCLUSION: Widespread patient payments constitute a major financial barrier to health service use in CEE. There is a need to formalize them where they are informal and to take measures to protect vulnerable population groups, especially those with limited possibilities to deal with payment difficulties.
| S-EPMC4032479 | biostudies-other
Project description:BackgroundDIALOG+ is an evidence-based, generic, cost-saving and easily deliverable psychosocial intervention, adaptable to clinicians' personal manner of interaction with patients. It was implemented in mental health services in five low- and middle-income countries in South-Eastern Europe during a 12-month randomised-controlled trial (IMPULSE) to improve the effectiveness of out-patient treatment for people with psychotic disorders.AimsTo investigate barriers and facilitators to the perceived sustainability of DIALOG+ that has been successfully implemented as a part of the IMPULSE project.MethodThree months after the IMPULSE trial's end, perceived sustainability of the DIALOG+ intervention was assessed via a short survey of clinicians and patients who took part in the trial. Quantitative data collected from the survey were analysed using descriptive statistics; content analysis assessed qualitative survey data. The views and experiences of key informants (patients, clinicians and healthcare policy influencers) regarding the sustainability and scale-up of DIALOG+ were further explored through semi-structured interviews. These data were explored using framework analysis.ResultsClinicians mostly appreciated the comprehensiveness of DIALOG+, and patients described DIALOG+ meetings as empowering and motivating. The barrier most commonly identified by key informants was availability of financial resources; the most important facilitators were the clinically relevant structure and comprehensiveness of the DIALOG+ intervention.ConclusionsParticipants showed a willingness to sustain the implementation of DIALOG+. It is important to maintain collaboration with healthcare policy influencers to improve implementation of DIALOG+ across different levels of healthcare systems and ensure availability of resources for implementing psychosocial interventions such as DIALOG+.
| S-EPMC9438482 | biostudies-literature