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Naess O.,National Institute of Public Health
Scandinavian journal of public health

In this paper we present multilevel models of individuals' residential history at multiple time points through the life course and their application and discuss some advantages and disadvantages for their use in epidemiological studies. Literature review of research using longitudinal multilevel models in studies of neighbourhood effects, statistical multilevel models that take individuals' residential history into account, and the application of these models in the Oslo mortality study. Measures of variance have been used to investigate the contextual impact of membership to collectives, such as area of residence, at several time points. The few longitudinal multilevel models that have been used suggest that early life area of residence may have an effect on mortality independently of residence later in life although the proportion of variation attributable to area level is small compared to individual level. The following multilevel models have been developed: simple multilevel models for each year separately, a multiple membership model, a cross-classified model, and finally a correlated cross-classified model. These models have different assumptions regarding the timing of influence through the life course. To fully recognise the origin of adult chronic diseases, factors at all stages of the life course at both individual and area level needs to be considered in order to avoid biased estimates. Important challenges in making life course residential data available for research and assessing how changing administrative coding over time reflect contextual impact need to be overcome before these models can be implemented as normal practice in multilevel epidemiology. Source

Zasada A.A.,National Institute of Public Health
Emerging Infectious Diseases

Twenty-five cases of nontoxigenic Corynebacterium diphtheriae infection were recorded in Poland during 2004-2012, of which 18 were invasive. Alcoholism, homelessness, hepatic cirrhosis, and dental caries were predisposing factors for infection. However, for 17% of cases, no concomitant diseases or predisposing factors were found. Source

Borrowing money is a common strategy to cope with health care costs. The impact of borrowing on households can be severe, leading to indebtedness and further impoverishment. However, the available literature on borrowing practices for health is limited. We explore borrowing practices for paying for health care by the poor in Cambodia and provide a typology, associated conditions, and the extent of the phenomenon. In addition to a semi-structured literature review, in-depth interviews were conducted with representatives of 47 households with health-related debt and 19 managers of formal or informal credit schemes. A large proportion of Cambodians, especially the poor, resort to borrowing to meet the cost of health care. Because of limited cash flow and access to formal creditors, the majority take out loans with high interest rates from informal money lenders. The most common type of informal credit is locally known as Changkar and consists of five kinds of loans: short-term loans, medium-term loans, seasonal loans, loans for an unspecified period, and loans with repayment in labour, each with different lending and repayment conditions and interest rates. This study suggests the importance of informal credit for coping with the cost of treatment and its potentially negative impact on the livelihood of Cambodian people. We provide directions for further studies on financial protection interventions to mitigate harmful borrowing practices to pay for health care in Cambodia. Source

AbouZahr C.,CAZ Consulting | De Savigny D.,Swiss Tropical and Public Health Institute | Mikkelsen L.,LM Consulting | Setel P.W.,Union North America | And 2 more authors.
The Lancet

The health and development challenges of the coming decades cannot be tackled effectively without reliable data for births, deaths, and causes of death, which only a comprehensive civil registration and vital statistics (CRVS) system can deliver. Alternative methods such as surveys, censuses, or surveillance are not adequate substitutes from a statistical perspective, and do not provide individuals with the legal documentation they need to benefit from services and participate fully in a modern society. Research is needed to generate and disseminate evidence about which CRVS strategies work best in which contexts and to ensure that the potential benefits of innovation are successfully scaled up, and that possible pitfalls are avoided. Research findings need to be compiled and made readily accessible to users for policy making, programming, and practice. Modernisation of CRVS systems necessitates new, broad-based national and international coalitions. The global architecture for CRVS, so far dominated by UN agencies, should extend to include bilateral donors, funds, foundations, non-governmental organisations, the private sector, academic institutions, and civil society. This change is essential to ensure that further development of CRVS systems is inclusive, participatory, multisectoral, and has a strong evidence base. © 2015 Elsevier Ltd. Source

Gut W.,National Institute of Public Health
Przegla̧d epidemiologiczny

The imbalance of Th1/Th2 cytokine concentrations and increased level of IgE might be useful tool for prediction of severity of RSV infection among young children and possibility of sequels. The ratio of cytokines Th1/Th2 varied during the disease. THE AIM of our studies was the assessment of immunological response by dynamics of Th1 and Th2 cytokines and IgE in RSV infections. Study was done on sera collected from 36 young children hospitalized because of RSV infection and from 16 children with other respiratory tract infection (HMPV, EV, HPIV1-3). Assaying of the serum levels of cytokine Th1 (IL-2, IFN-g, TNF), Th2 (IL-4, IL-6, IL-10) and concentration of IgE has been done. Paired sera (48 patients) were collected in the interval 4-14 days. Reference group consist of 18 children (< 6 months of life) hospitalised because other than respiratory diseases with negative results for viruses tested by PCR. Among children with respiratory infection the Th1/Th2 ratio was shifted towards Th2, level of IgE increased in comparison to the reference group. Changes in concentration of IL-6, IFN-g, IL-10 were related to RSV infection, mainly bronchitis and bronchiolitis, while the dynamic of TNF concentration was independent on aetiological agent. It was found that the risk factors (prematurity, artificial nutrition) correlated with RSV bronchitis and the levels of cytokines and IgE. Increased level of IL-6 and IL-10 were shown in prematures, and increased concentration of IgE--among artificial nourished children. The time of serum collection affected the level of cytokines and IgE and the effect was depended on the aetiological agent. In RSV infections was observed significant decrease with time of IL-6, IL-10 and IFN-gamma but not IgE (still significantly higher than in the reference group). While the significant decrease of IgE was determined only in other than RSV infections. Determined level of cytokines and IgE varied depending on the time of serum collection. Observed dynamics in paired sera and IgE might have prognostic value in disease and sequels of RSV infections. Prevention RSV infection in premature infants should be done in any possible way. Breastfeeding is one of the critical elements of prevention of RSV infection. Source

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