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Biomedical subjects

Ulrich Laaser

Publications and source records attributed to Ulrich Laaser.

At least 19 recordsLinked to original sources
PubMed2007

The burden of type 2 diabetes in Serbia and the cost-effectiveness of its management.

The purpose of this study was to analyse whether the nationwide application of the national Serbian guideline for diabetes mellitus (NSGDM) would save a relevant amount of disability-adjusted life years (DALYs) and/or reduce the medical cost of treating diabetic patients in Serbia, as compared to the present situation. Disability-adjusted life years were calculated for Serbia and the cost-effectiveness was analysed in eight population groups under ideal and present conditions; prevalent and incident cases were each split up for patients with blood glucose that was well controlled and that was uncontrolled. Under ideal conditions, i.e., according to the NSGDM, 8,031 DALYs could be saved with a potential cost reduction at the same time of approximately 19 million Euros. The implementation of the NSGDM in clinical practice bears a great potential to save lives and reduce years lived with lowered quality of life, but in addition it may reduce costs by about a quarter.

Cost of Illness↗
PubMed2006

Health-related quality of life in diabetic patients and controls without diabetes in refugee camps in the Gaza strip: a cross-sectional study.

BACKGROUND: Prevalence of diabetes mellitus is increasing in developed and developing countries. Diabetes is known to strongly affect the health-related quality of life (HRQOL). HRQOL is also influenced by living conditions. We analysed the effects of having diabetes on HRQOL under the living conditions in refugee camps in the Gaza strip. METHODS: We studied a sample of 197 diabetic patients who were recruited from three refugee camps in the Gaza strip and 197 age- and sex-matched controls living in the same camps. To assess HRQOL, we used the World Health Organization Quality of Life questionnaire (WHOQOL-BREF) including four domains (physical health, psychological, social relations and environment). Domain scores were compared for cases (diabetic patients) and controls (persons without diabetes) and the impact of socio-economic factors was evaluated in both groups. RESULTS: All domains were strongly reduced in diabetic patients as compared to controls, with stronger effects in physical health (36.7 vs. 75.9 points of the 0-100 score) and psychological domains (34.8 vs. 70.0) and weaker effects in social relationships (52.4 vs. 71.4) and environment domains (23.4 vs. 36.2). The impact of diabetes on HRQOL was especially severe among females and older subjects (above 50 years). Low socioeconomic status had a strong negative impact on HRQOL in the younger age group (<50 years). CONCLUSION: HRQOL is strongly reduced in diabetic patients living in refugee camps in the Gaza strip. Women and older patients are especially affected.

Adult↗
PubMed2006

The burden of disease and injury in Serbia.

BACKGROUND: In the last decade of the 20th century, a considerable effort has been put into the development of summary measures of population health that combine information on mortality and non-fatal health outcomes. We used the DALYs (Disability adjusted life years) method to assess the burden of disease and injury in the population of Serbia. METHODS: Our study, largely based on the methods developed for the Global burden of disease study, was conducted between October 2002 and September 2003. DALYs, stratified by gender and age, were calculated for 18 selected health conditions for the population of Serbia, Serbia and Montenegro for 2000. Years of life lost (YLL) were calculated using country mortality statistics, while years lived with disability (YLD) were calculated using different sources of information. Also, the YLD/YYL ratio and age-adjusted rates of DALYs were calculated. RESULTS: Ischaemic heart disease, cerebrovascular diseases, lung cancer, unipolar depressive disorders, and diabetes mellitus were responsible for almost two-thirds (70%) of the total burden of 18 selected disorders in Serbia 2000. The leading five causes for males were ischaemic heart disease (26.1 DALY per 1000), stroke (17.9), lung cancer (12.7), road traffic accidents (6.5), and self-inflicted injuries (5.5). For females, the leading five causes were stroke (18.1 DALY per 1000), ischaemic heart disease (14.1), depression (8.7), breast cancer (6.1), and diabetes mellitus (5.2). CONCLUSIONS: The final results of the study have shown that the national health priority areas should cover cardiovascular diseases, cancers, and mental health.

Cost of Illness↗
PubMed2006

Building public health associations in the transition countries of south-eastern Europe: the example of Albania.

The Albanian Forum of Public Health (AFPH), an umbrella organization including different public health associations operating in Albania, was established in March 2004 with the support of the European Public Health Association (EUPHA) and the Open Society Institute (OSI). Ever since its establishment the AFPH has been an open arena wherein opinions and options for rational health policies comprising all relevant issues of the New Public Health are discussed, formulated, and documented near the Albanian Ministry of Health. Notwithstanding the laudable mission of the AFPH, there is an emerging need to establish a regional Public Health Forum in south-east Europe as a basic prerequisite for sustainable development of public health in these countries. Most conveniently, this regional umbrella organization should have a supporting Secretariat based in one of the south-east European countries. Nevertheless, there is a clear call for international funding with participation of different agencies and bodies (OSI, EUPHA, Canadian International Development Agency, and the Stability Pact). A regional association in the south-east Europe would enable the organization of annual conferences in the most renowned institutions in the region. Also, a regional collaboration among public health associations would be a suitable start for the development of research in south-east Europe. Furthermore, the existence of a regional public health association would make feasible the establishment of a scientific public health journal for south-east Europe in the English language.

Adolescent↗
PubMed2006

Premature mortality in Slovenia in relation to selected biological, socioeconomic, and geographical determinants.

AIM: To determine biological (sex and age), socioeconomic (marital status, education, and mother tongue) and geographical (region) factors connected with causes of death and lifespan (age at death, years-of-potential-life-lost, and mortality rate) in Slovenia in the 1990s. METHODS: In this population-based cross-sectional study, we analyzed all deaths in the 25-64 age group (N=14 816) in Slovenia in 1992, 1995, and 1998. Causes of death, classified into groups according to the 10th revision of International Classification of Diseases, were linked to the data on the deceased from the 1991 Census. Stratified contingency-table analyses were performed. Years-of-potential-life-lost (YPLL) were calculated on the basis of population life-tables stratified by region and linearly modeled by the characteristics of the deceased. Poisson regression was applied to test the differences in mortality rate. RESULTS: Across all socioeconomic strata, men died at younger age than women (index of excess mortality in men exceeded 200 for all studied years) and from different prevailing causes (injuries in men aged <45 years; neoplasms in women aged >35 years). For men, higher education was associated with fewer deaths from digestive and respiratory system diseases. The least educated women died relatively often from circulatory diseases, but rarely from neoplasms. Single people died from neoplasms less often. Marriage in comparison with divorce reduced the mortality rate by 1.9-fold in both men and women (P<0.001). Mortality rate in both men and women decreased with increasing education level (P<0.001). Mortality rate of ethnic Slovenians was half the mortality rate of ethnic minority members and immigrants (P<0.001). Analysis of YPLL revealed limited and nonlinear impact of education level on premature mortality. The share of neoplasms was the highest in the cluster of socioeconomically prosperous regions, whereas the share of circulatory diseases was increased in poorer regions. Significant differences were found between individual regions in age at death and mortality rate, and the differences decreased over the studied period. CONCLUSION: These data may aid in understanding the nature, prevalence and consequences of mortality as related to socioeconomic inequalities, and thus serve as a basis for setting health and social policy goals and planning health measures.

Adult↗
PubMed2005

Trends in risk factor control in Germany 1984-1998: high blood pressure and total cholesterol.

BACKGROUND: Diagnosis and treatment of the two primary cardiovascular risk factors, hypertension and hypercholesterolaemia, are well established. Nevertheless, according to earlier analyses of representative health questionnaire and examination surveys in 1984, 1988 and 1991, control of risk factors in the sense of normalized values through drug therapy did not improve to any relevant degree in former West Germany. The National Health Survey of 1998 now allows the reconsideration of the hypothesis that medical treatment has been improving and lead to a reduction of risk factor values measured in the population. METHODS: Datasets of independent cross-sectional studies in 1984, 1988, 1991 and 1998 with net random sample sizes between 3,458 and 5,335 were analysed for actual (persons with elevated values and persons successfully treated) and population (persons with elevated values) prevalence, awareness of the risk factors under question, treatment coverage (risk factor aware and treated) and effectiveness (risk factor aware, treated and normalized), and the resulting parameters of controlled (successfully treated persons among actual prevalence) and uncontrolled prevalence (persons with elevated values among actual prevalence), respectively. Thresholds chosen were blood pressure values >or=160/95 mmHg for hypertension and values >or=250 mg/dl for hypercholesterolaemia. Regarding medication, the answer of 'one to two times weekly' or more was considered to indicate a relevant drug intake. RESULTS: For hypertension the population prevalence (population 30-69 years old) increased significantly (P < 0.0001) from 19.6% to 24.0% between 1984 and 1998, whereas the actual prevalence rose less steeply but still significantly (P < 0.0002) from 32.5% to 34.4%. For hypercholesterolaemia the population prevalence stagnated at 37.0% (1998), whereas the actual prevalence was 47.5% in 1998 (39.1% in 1984; P < 0.0001). For hypertension treatment, coverage improved from 45.4% to 63.0%, but treatment effectiveness decreased from 51.7% to 41.3%, both trends being highly significant. For hypercholesterolaemia, awareness increased from 18.3% to 57.6%, but treatment coverage decreased from 33.5% to 15.5%, whereas treatment effectiveness improved from 23.8% to 47.7%, all trends being highly significant (P < 0.0001). CONCLUSIONS: The results do not support the hypothesis that medical care for the large population at cardiovascular risk in (Western) Germany was adequate and successful in the 1980s and 1990s.

Adult↗
PubMed2005

Factors associated with spousal physical violence in Albania: cross sectional study.

OBJECTIVE: To describe the prevalence of intimate partner violence and associated factors among married women in Albania. DESIGN: Cross sectional study. SETTING: Tirana, the capital city of Albania. PARTICIPANTS: A representative sample of 1039 married women aged 25-65 living in Tirana and recorded in the 2001 census. METHODS: Questionnaire on intimate partner violence and social and demographic characteristics of the women and their husbands. MAIN OUTCOME MEASURE: Women's experience within the past year of being hit, slapped, kicked, or otherwise physically hurt by the husband. RESULTS: More than a third (37%, 384/1039) of women had experienced violence. Risk was greatest among women aged 25-34 (odds ratio 1.47, 95% CI 1.04 to 2.09), women with tertiary education (3.70, 2.04 to 6.67), women in white collar jobs (4.0, 1.59 to 10.0), women with least educated husbands (5.01, 2.91 to 8.64), and women married to men raised in rural areas (3.31, 2.29 to 4.80). Women were at higher risk if they were more educated than their husbands (4.76, 2.56 to 9.09). CONCLUSIONS: In transitional Albania, the risk of spousal violence is high, and more empowered women are at greater risk.

Adult↗
PubMed2005

Regional collaboration in public health training and research among countries of South Eastern Europe.

UNLABELLED: It is argued that each country of South Eastern Europe should have its own school of public health. However, a basic prerequisite of modern public health training is the comprehensiveness of the programme and a worldview approach. Most of the countries of South Eastern Europe face the same difficulties to adapt their inherited communist structures of public health training to Western standards. A regional collaboration would facilitate the process of establishing schools of public health in all countries of the region and support the training of public health professionals at all levels. KEY POINTS: South East Europe includes Albania, Bosnia and Herzegovina, Bulgaria, Croatia, Greece, Macedonia, Moldavia, Romania, Serbia and Montenegro, and Slovenia. Public health institutions in South East Europe face similar difficulties to adapt their inherited teaching structures to Western standards. Public health institutions in South East Europe should make a joint effort towards establishing regional training programmes. A regional approach in public health training would enable an efficient use of resources in countries of South East Europe.

Communism↗
PubMed2002

Prevalence and risk factors of HBsAg in Gaza: implications for prevention and control.

The Epidemiology of hepatitis B virus (HBV) infection was not precisely known in Gaza. This study investigated the prevalence and risk factors of hepatitis B surface antigen (HBsAg) and simulated the incidence of HBV infection from reported cases of acute hepatitis due to HBV. Blood samples from 810 randomly selected individuals from the general population and from 17,060 blood donors were tested for HBsAg. The prevalence of HBsAg was found to be 3.5% in the general population and 3.8% in blood donors. The simulation model revealed the incidence of HBV infection decreased between 1990 and 1999 from 233 to 56 per 100,000 per annum. The decline started in 1994 and continued afterwards, presumably after the introduction of universal vaccination against HBV and screening blood donors for HBV. However, the authors discuss additional measures to control the transmission of HBV among non-vaccinated cohorts.

Adolescent↗
PubMed2002

Public health and peace.

The modern concept of public health, the New Public Health, carries a great potential for healthy and therefore less aggressive societies. Its core disciplines are health promotion, environmental health, and health care management based on advanced epidemiological methodologies. The main principles of living together in healthy societies can be summarized as four ethical concepts of the New Public Health essential to violence reduction equity, participation, subsidiarity, and sustainability. The following issues are discussed as violence determinants: the process of urbanization; type of neighborhood and accommodation, and consequent stigmatization; level of education; employment status; socialization of the family; women's status; alcohol and drug consumption; availability of the firearms; religious, ethnic, and racial prejudices; and poverty. Development of the health systems has to contribute to peace, since aggression, violence, and warfare are among the greatest risks for health and the economic welfare. This contribution can be described as follows: 1) full and indiscriminate access to all necessary services, 2) monitoring of their quality, 3) providing special support to vulnerable groups, and 4) constant scientific and public accountability of the evaluation of the epidemiological outcome. Violence can also destroy solidarity and social cohesion of groups, such as family, team, neighborhood, or any other social organization. Durkheim coined the term anomie for a state in which social disruption of the community results in health risks for individuals. Health professionals can make a threefold contribution to peace by 1) analyzing the causal interrelationships of violence phenomena, 2) curbing the determinants of violence according to the professional standards, and 3) training professionals for this increasingly important task. Because tolerance is an essential part of an amended definition of health, monitoring of the early signs of public intolerance is important. The vital interplay between the informed public and efficient administration, however, can only exist in an open society. The link between democracy and health of the people, and between public health and economic welfare is real. The Public Health Collaboration in South Eastern Europe (PH-SEE) evolved just in time to reconnect and strengthen disrupted professional networks in the region as a prerequisite of effective public health action.

Croatia↗
PubMed2002

Burden of tuberculosis in Afghanistan: update on a war-stricken country.

AIM: To review Afghans Tuberculosis (TB) Control Program and assesses the impact of disruption induced by the war in Afghanistan. METHODS: National TB control program of Afghanistan was reviewed in terms of its milestones, achievement parameters, and potential barriers. Information and data were collected by review visits to the Ministry of Health and health facility survey of non-governmental organizations working for TB control in Afghanistan. Local and international literature was consulted. RESULTS: Mortality and morbidity figures due to tuberculosis remained alarmingly high in the last two decades, especially among women. Current estimates show that the incidence of active TB cases is 278 per 100,000 and mortality mounts to 15,000 cases per year. The epidemiological profile reflecting the situation of Afghans inside and outside the country is extremely deplorable. The situation has worsened due to the cessation of TB control activities during the war. Compliance of patients and access to the treatment has become very difficult in an emergency situation. Similarly, an increasing number of TB cases among Afghans refugees in Pakistan have also been observed. Overcrowded refugee camps and lack of treatment facilities increases manyfold the risk of further transmission. CONCLUSION: TB is a major public health threat inside and outside war-stricken Afghanistan. TB control activities need prompt attention of health authorities in reestablishing TB control network. World Health Organization's guidelines and nationwide Directly Observed Treatment Short Course strategy should be adopted and sufficient resources allocated. It is vital to build a peaceful environment with a viable and durable alliance of local and international donors in the fight against TB.

Adult↗
PubMed2002

Urging health system research: identifying gaps and fortifying tuberculosis control in Pakistan.

AIM: To assess the significance of health system research in reducing the burden of tuberculosis and improving the performance of National Tuberculosis Control Program in Pakistan. METHOD: Qualitative and quantitative content analysis of research papers on tuberculosis and influence of the research knowledge on the efficiency of the National Tuberculosis Control Program. RESULTS: We analyzed 268 research papers on tuberculosis in Pakistan published in the 1960-2002 period, from both national and international perspectives. The majority of the studies covered epidemiology of tuberculosis (n=76) in Pakistan, whereas the rest of the papers addressed issues like pediatric tuberculosis (n=53), tuberculosis among Pakistani immigrants (n=35), tuberculosis-HIV synergism (n=24), care seeking (n=19), adherence with tuberculosis treatment (n=14), tuberculosis among women (n=12), tuberculosis prevention (n=12), directly observed treatment short-course (DOTS) strategy modification (n=5), tuberculosis drug resistance (n=7), operational research (n=5), tuberculosis case management (n=4), and research on Mycobacterium (n=2). Qualitative analysis revealed that research and spending on tuberculosis policy and nationwide tuberculosis interventions are not sufficient. Available research knowledge has not yet been translated into the tuberculosis policy and interventions. Furthermore, the lack of insight of the health system on community dynamics and tuberculosis intervention has led to failure in achieving the desired targets in tuberculosis control. CONCLUSION: Health system in Pakistan needs to improve tuberculosis control interventions by conducting extensive research on the various potential weaknesses in the field. For an effective tuberculosis eradication program in a highly endemic country such as Pakistan, health system research should be an integral part of the National Tuberculosis Control Program.

Child↗