Inequalities in Out-of-Pocket Health Expenditure Measured Using Financing Incidence Analysis (FIA): A Systematic Review.

Government efforts and reforms in health financing systems in various countries are aimed at achieving universal health coverage. Household spending on healthcare plays a very important role in achieving this goal. The aim of this systematic review was to assess out-of-pocket health expenditure inequalities measured by the FIA across different territories, in the context of achieving UHC by 2030. A comprehensive systematic search was conducted in the PubMed, Scopus, and Web of Science databases to identify original quantitative and mixed-method studies published in the English language between 2016 and 2022. A total of 336 articles were initially identified, and after the screening process, 15 articles were included in the systematic review, following the removal of duplicates and articles not meeting the inclusion criteria. Despite the overall regressivity, insurance systems have generally improved population coverage and reduced inequality in out-of-pocket health expenditures among the employed population, but regional studies highlight the importance of examining the situation at a micro level. The results of the study provide further evidence supporting the notion that healthcare financing systems relying less on public funding and direct tax financing and more on private payments are associated with a higher prevalence of catastrophic health expenditures and demonstrate a more regressive pattern in terms of healthcare financing, highlighting the need for policy interventions to address these inequities. Governments face significant challenges in achieving universal health coverage due to inequalities experienced by financially vulnerable populations, including high out-of-pocket payments for pharmaceutical goods, informal charges, and regional disparities in healthcare financing administration.

An analysis of financial protection and financing incidence of out-of-pocket health expenditures in Kazakhstan from 2018 to 2021.

Universal health coverage relies on providing essential medical services and shielding individuals from financial risks. Our study assesses the progressivity of out-of-pocket (OOP) payments, identifies factors contributing to healthcare expenditure inequality, and examines catastrophic health expenditures (CHE) prevalence in Kazakhstan from 2018 to 2021. Using retrospective analysis of National Statistics Bureau data, we employed STATA 13 version for calculations CHE incidence, progressivity, Lorenz and concentration curves. In 2020-2021, OOP expenditures in Kazakhstan decreased, reflecting a nearly twofold reduction in the CHE incidence to 1.32% and 1.24%, respectively. However, during these years, we observe a transition towards a positive trend in the Kakwani index to 0.003 and 0.005, respectively, which may be explained by household size and education level factors. Increased state financing and quarantine measures contributed to reduced OOP payments. Despite a low healthcare expenditure share in gross domestic product, Kazakhstan exhibits a relatively high private healthcare spending proportion. The low CHE incidence and proportional expenditure system suggest private payments do not significantly impact financial resilience, prompting considerations about the role of government funding and social health insurance in the financing structure.

Descriptive characteristics of occupational exposures and medical follow-up in the cohort of workers of the Siberian Group of Chemical Enterprises in Seversk, Russia.

PURPOSE: To date, only a few studies have examined long-term health risks of exposures in the uranium processing industry and reported contradictory results, necessitating further research in this area. This is the first description of a cohort of ∼65,000 uranium processing workers (20.6% women) of the Siberian Group of Chemical Enterprises (SGCE) in Seversk, Russia, first employed during 1950-2010. METHODS: SGCE is one of the largest and oldest uranium processing complexes in the world. SGCE workers at the Radiochemical, Plutonium, Sublimate and Enrichment plants were exposed to a combination of internal and external radiation, while workers at the Support Facility were primarily exposed to non-radiation factors. RESULTS: Mean cumulative gamma-ray dose based on individual external dosimetry was 28.3 millisievert. About 4,000 workers have individual biophysical survey data that could be used for estimation of organ doses from uranium. SGCE workers were followed up for mortality and cancer incidence during 1950-2013 (vital status known for 80.8% of workers). The SGCE computerized database contains information on the results of regular medical examinations, and on smoking, alcohol and other individual characteristics. CONCLUSIONS: The SGCE cohort is uniquely suited to examine long-term health risks of exposures to gamma-radiation and long-lived radionuclides in uranium processing workers.

Insights on Nutrients as Analgesics in Chronic Pain.

Many serious inflammatory disorders and nutrient deficiencies induce chronic pain, and anti-inflammatory diets have been applied successfully to modify the inflammatory symptoms causing chronic pain. Numerous scientific data and clinical investigations have demonstrated that long-term inflammation could lead to an inappropriate or exaggerated sensibility to pain. In addition, some Non-steroidal Anti-inflammatory Drugs (NSAID), which directly act on the many enzymes involved in pain and inflammation, including cyclooxygenases, are used to dampen the algesic signal to the central nervous system, reducing the responses of soft C-fibers to pain stimuli. On the other hand, there are a few reports from both health authorities and physicians, reporting that decreased transmission of pain signals can be achieved and improved, depending on the patient's dietary habit. Many nutrients, as well as a suitable level of exercise (resistance training), are the best methods for improving the total mitochondrial capacity in muscle cells, which can lead to a reduction in sensitivity to pain, particularly by lowering the inflammatory signaling to C-fibers. According to the current literature, it could be proposed that chronic pain results from the changed ratio of neuropeptides, hormones, and poor nutritional status, often related to an underlying inflammatory disorder. The current review also evaluates the effective role of nutrition-related interventions on the severity of chronic pain. This review pointed out that nutritional interventions can have a positive effect on pain experience through the indirect inhibitory effect on prostaglandin E2 and attenuation of mitochondrial dysfunction caused by ischemia/reperfusion in skeletal muscle, improving the intracellular antioxidant defense system. These data highlight the need for more nutrition studies where chronic pain is the primary outcome, using accurate interventions. To date, no nutritional recommendation for chronic pain has been officially proposed. Therefore, the goal of this article is to explore pain management and pain modulation, searching for a mode of nutrition efficient in reducing pain.

Molecular Relationships between Bronchial Asthma and Hypertension as Comorbid Diseases.

Comorbidity, a co-incidence of several disorders in an individual, is a common phenomenon. Their development is governed by multiple factors, including genetic variation. The current study was set up to look at associations between isolated and comorbid diseases of bronchial asthma and hypertension, on one hand, and single nucleotide polymorphisms associated with regulation of gene expression (eQTL), on the other hand. A total of 96 eQTL SNPs were genotyped in 587 Russian individuals. Bronchial asthma alone was found to be associated with rs1927914 (TLR4), rs1928298 (intergenic variant), and rs1980616 (SERPINA1); hypertension alone was found to be associated with rs11065987 (intergenic variant); rs2284033 (IL2RB), rs11191582 (NT5C2), and rs11669386 (CARD8); comorbidity between asthma and hypertension was found to be associated with rs1010461 (ANG/RNASE4), rs7038716, rs7026297 (LOC105376244), rs7025144 (intergenic variant), and rs2022318 (intergenic variant). The results suggest that genetic background of comorbidity of asthma and hypertension is different from genetic backgrounds of both diseases manifesting isolated.

Increased prevalence of essential hypertension in areas previously exposed to fallout due to nuclear weapons testing at the Semipalatinsk Test Site, Kazakhstan.

This study examines the association between environmental radiation exposure and essential hypertension in a series of investigated geographical districts adjacent to the Semipalatinsk nuclear test site in Kazakhstan. The sample consists of 2000 volunteers participants in screening examinations in three administrative districts close to the nuclear test site, which was carried out as part of the Government Programs on Environmental Health Hazard. The cross-sectional study compares prevalence ratios in a population sample with long-term exposure in the low and intermediate dose range. Age-adjusted odds ratios for hypertension were found significantly increased with higher exposure groups. After accounting for main cardiovascular risk factors into the model and stratifying by gender, the prevalence odds ratios for radiation remained significantly increased, with a significant dose-response effect observed for some but not all subgroups. The results support existing evidence of cardiovascular health effects of radiation exposure and of persisting environmental health issues that require attention in both epidemiological surveys and healthcare provision.

Awareness of cardiovascular disease, its risk factors, and its association with attendance at outpatient clinics in acute coronary syndrome patients.

BACKGROUND: The objective was to assess patients' awareness of cardiovascular disease, its risk factors, and its association with attendance at outpatient clinics in patients with acute coronary syndrome (ACS). METHODS: All patients of the Lyubertsy Infarct Survival Study-3 registry hospitalized with ACS from November 1, 2013, to July 31, 2015, were included (n = 397). We used medical histories and specifically designed checklists. Awareness was assessed in survived patients (n = 320) for dyslipidemia, diabetes, arterial hypertension, and previous myocardial infarction. Patients were divided into three groups depending on their attendance at outpatient clinics prior to ACS: attendants, partially compliant to attendance, and nonattendants. RESULTS: Our study showed several differences between medical history data received from patients and data obtained from objective examination, which was true for arterial hypertension (p < 0.05) and particularly for dyslipidemia (p < 0.01). The majority of patients were aware of diabetes. All patients knew about previous myocardial infarction. Awareness of arterial hypertension slightly increased with increasing attendance (p > 0.05), whereas awareness of dyslipidemia increased dramatically (p < 0.01). CONCLUSION: Our study showed significant differences between medical history data received from patients and data obtained from objective examination for several cardiovascular disease risk factors in patients with ACS. Awareness of dyslipidemia was very low. It increased dramatically with increasing attendance. At the same time, there was only a slight increase in awareness of arterial hypertension with increase of attendance.

The risk of acute myocardial infarction and arterial hypertension in a cohort of male employees of a Siberian Group of Chemical Enterprises exposed to long-term irradiation.

During the period from 1998 to 2007, a prospective cohort study of acute myocardial infarction morbidity cases as well as a "case-control" study of arterial hypertension was carried out. The risk of acute myocardial infarction was assessed as well as arterial hypertension; the dose-response relationship and the role of radiation in the mechanism of acute myocardial infarction as well as arterial hypertension development were studied. As a result of this study, a statistically significant increased risk of acute myocardial infarction among the male staff at the Siberian Group of Chemical Enterprises [standardized relative risk = 1.16 (1.04; 1.29)] exposed to external irradiation in comparison with employees unexposed to ionizing radiation was observed. A significant increase in the risk of acute myocardial infarction was observed at external radiation dose accumulation of more than 300 mSv [standardized relative risk = 1.46 (1.09; 1.91)]. The increase in arterial hypertension risk has been established among the analyzed group of employees exposed to long-term irradiation in the absence of the linear dependence of risk, based on cumulative dose of external γ-irradiation [risk due to external radiation dose in the range of 7.3-21.3 mSv = 1.6 (0.96; 2.51) and in the range of external radiation dose 21.4-68.5 mSv = 1.7 (1.04; 2.67) for 68.6-864 mSv = 1.6 (1.01; 2.57)]. This led to the conclusion that radiation can act also as a factor that might potentiate the negative effects of the "traditional" risk factors in the pathogenesis of acute myocardial infarction and hypertension.

Behavior and food consumption pattern of the population exposed in 1949-1962 to fallout from Semipalatinsk nuclear test site in Kazakhstan.

The relationship between radiation exposure from nuclear weapons testing fallout and thyroid disease in a group of 2,994 subjects has been the subject of study by the US National Cancer Institute. In that study, radiation doses to the thyroid were estimated for residents of villages in Kazakhstan possibly exposed to deposition of radioactive fallout from nuclear testing conducted by the Soviet Union at the Semipalatinsk Nuclear Test Site in Kazakhstan between 1949 and 1962. The study subjects included individuals of both Kazakh and Russian origin who were exposed during childhood and adolescence. An initial dose reconstruction used for the risk analysis of Land et al. (Radiat Res 169:373-383, 2008) was based on individual information collected from basic questionnaires administered to the study population in 1998. However, because data on several key questions for accurately estimating doses were not obtained from the 1998 questionnaires, it was decided to conduct a second data collection campaign in 2007. Due to the many years elapsed since exposure, a well-developed strategy was necessary to encourage accurate memory recall. In our recent study, a focus group interview data collection methodology was used to collect historical behavioral and food consumption data. The data collection in 2007 involved interviews conducted within four-eight-person focus groups (three groups of women and one group of men) in each of four exposed villages where thyroid disease screening was conducted in 1998. Population-based data on relevant childhood behaviors including time spent in- and outdoors and consumption rates of milk and other dairy products were collected from women's groups. The data were collected for five age groups of children and adolescents ranging from less than 1 year of age to 21 years of age. Dairy products considered included fresh milk and other products from cows, goats, mares, and sheep. Men's focus group interviews pertained to construction materials of houses and schools, and animal grazing patterns and feeding practices. The response data collected are useful for improving estimates of thyroid radiation dose estimates for the subjects of an ongoing epidemiological study.