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To inform strategies aimed at improving blood pressure (BP) control and reducing salt intake, we assessed educational inequalities in high blood pressure (HBP) awareness, treatment and control; physician's advice on salt reduction; and salt knowledge, perceptions and consumption behaviours in Eastern Europe and Central Asia. Data were collected in cross-sectional, population-based nationally representative surveys, using a multi-stage clustered sampling design. Five HBP awareness, treatment and control categories were created from measured BP and hypertension medication use. Education and other variables were self-reported. Weighted multinomial mixed-effects regression models, adjusted for confounders, were used to assess differences across education categories. Nine Eastern European and Central Asian countries (Armenia, Azerbaijan, Belarus, Georgia, Kyrgyzstan, Republic of Moldova, Tajikistan, Turkey and Uzbekistan). Nationally representative samples of 30 455 adults aged 25-65 years. HBP awareness, treatment and control varied substantially by education. The coverage of physician's advice on salt was less frequent among participants with lower education, and those with untreated HBP or unaware of their HBP. The education gradient was evident in salt knowledge and perceptions of salt intake but not in salt consumption behaviours. Improved salt knowledge and perceptions were more prevalent among participants who received physician's advice on salt reduction. There is a strong education gradient in HBP awareness, treatment and control as well as salt knowledge and perceived intake. Enhancements in public and patient knowledge and awareness of HBP and its risk factors targeting socio-economically disadvantaged groups are urgently needed to alleviate the growing HBP burden in low- and middle-income countries.

Abstract Background Self-reported measures of tobacco use may have limited validity, particularly among some populations. This study aims to validate self-reported smoking measures among Georgian adults participating in the 2016 STEPS survey using cotinine biomarker measurements, and to explore potential differences according to sociodemographic characteristics. Additionally, this paper examines how the estimated prevalence of smoking in the population varies according to measurement type. Methods Using the WHO standardized STEPS methodology, adults self-reported their smoking status. In a later stage of the survey, a subset of participants provided a urine sample, which was tested for cotinine. Using each participant’s objective cotinine measurement and their self-reported smoking status, we calculated the sensitivity, specificity and positive predictive value of self-reported smoking. Next, we calculated the estimated prevalence of smokers according to the type of measurement. Results Results indicated high sensitivity (83.37%, 95% CI: 76.79–88.37%) among males and relatively low sensitivity (38.60% CI: 29.23–48.90%) among females. According to self-report, the prevalence of smokers was 26.44% (23.61–29.48%), while according to cotinine detection, the prevalence of smokers was 32.27% (29.16–35.55%). Among all subgroups, the self-reported prevalence of smoking was significantly lower than the cotinine-detected prevalence. Conclusions To the best of our knowledge, this is the first time that the validity of the STEPS self-reported tobacco indicator has been tested. Self-reported measures of smoking status may lead to an under-estimation of smoking prevalence among Georgian adults, especially women. These findings suggest that integration of biochemical measures of smoking into tobacco use studies may be an important investment.

Resumen Varios sistemas procesales penales de Iberoamérica se estructuran para que un número importante de casos penales no concluya en un juicio jurisdiccional, sino que en un conjunto de salidas tempranas o alternativas en las que hay poca o nula participación del imputado y de la víctima, o no reúnen las características y estándares de un proceso contradictorio. En estos casos, aunque no se dé cumplimiento al derecho a un proceso previo, el estado debe garantizar que esas salidas tempranas o alternativas reúnan los estándares del debido proceso, poniendo atención en los casos que la igualdad de armas, el derecho a ser oído, el derecho a presentar pruebas y el derecho a no declarar contra sí mismo podrían verse afectados. En caso contrario, el estado deja de cumplir su deber de garantizar, a favor de todos, el derecho a la tutela judicial efectiva.

Over the past few decades, social and economic changes have had substantial effects on health and wellbeing in Russia. We aimed to use data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to evaluate trends in mortality, causes of death, years lived with disability (YLDs), years of life lost (YLLs), disability-adjusted life-years (DALYs), and associated risk factors in Russia from 1980 to 2016. We estimated all-cause mortality by use of a multistage modelling process that synthesised data from vital registration systems, surveys, and censuses. A composite measure of health loss due to both fatal and non-fatal disease burden (DALYs) was calculated as the sum of YLLs and YLDs for each age, sex, year, and location. Health progress was evaluated in comparison with patterns of change in similar countries by use of the Socio-demographic Index that was developed for GBD 2016. Following rapid decreases in life expectancy after the collapse of the Soviet Union, life expectancy at birth in Russia improved between 2006 and 2016. The all-cause mortality rate decreased by 16·6% (95% uncertainty interval 9·4–33·8) between 1980 and 2016. This overall decrease encompasses the cycles of sharp increases and plateaus in mortality that occurred before 2005. Child mortality decreased by 57·5% (53·5–61·1) between 2000 and 2016. However, compared with countries at similar Socio-demographic Index levels, rates of mortality and disability in Russia remain high and life expectancy is low. Russian men have a disproportionate burden of disease relative to women. In 2016, 59·2% (55·3–62·6) of mortality in men aged 15–49 years and 46·8% (44·5–49·5) of mortality in women were attributable to behavioural risk factors, including alcohol use, drug use, and smoking. Trends in mortality in Russia from 1980 to 2016 might be related to complicated patterns of behavioural risk factors associated with economic and social change, to shifts in disease burden, and to changes in the capacity of and access to health care. Ongoing mortality and disability from causes and risks amenable to health-care interventions and behaviour modifications present opportunities to continue to improve the wellbeing of Russian citizens. Bill & Melinda Gates Foundation.

Given n,m∈N and a simply connected uniform domain U⊂C with a sufficiently smooth boundary ∂U , we study the C* -algebra BU,n,m(L):=algaI,BU,1,…,BU,n,B~U,1,…,B~U,m:a∈X(L), generated by the operators of multiplication by functions in X(L) , by the poly-Bergman projections BU,1,…,BU,n and by the anti-poly-Bergman projections B~U,1,…,B~U,m acting on the Lebesgue space L2(U) . The C* -algebra X(L) is generated by the set SO∂(U) of all bounded continuous functions on U that slowly oscillate at points of ∂U and by the set PC(L) of all piecewise continuous functions on the closure U¯ of U with discontinuities on a finite union L of piecewise Dini-smooth curves that have one-sided tangents at every point z∈L , possess a finite set Y=L∩∂U , do not form cusps, and are not tangent to ∂U at the points z∈Y . Making use of the Allan-Douglas local principle, the limit operators techniques, quasicontinuous maps, and properties of SO∂(U) functions, a Fredholm symbol calculus for the C* -algebra BU,n,m(L) is constructed and a Fredholm criterion for its operators is obtained.

Resumen Varios sistemas procesales penales de Iberoamérica se estructuran para que un número importante de casos penales no concluya en un juicio jurisdiccional, sino que en un conjunto de salidas tempranas o alternativas en las que hay poca o nula participación del imputado y de la víctima, o no reúnen las características y estándares de un proceso contradictorio. En estos casos, aunque no se dé cumplimiento al derecho a un proceso previo, el estado debe garantizar que esas salidas tempranas o alternativas reúnan los estándares del debido proceso, poniendo atención en los casos que la igualdad de armas, el derecho a ser oído, el derecho a presentar pruebas y el derecho a no declarar contra sí mismo podrían verse afectados. En caso contrario, el estado deja de cumplir su deber de garantizar, a favor de todos, el derecho a la tutela judicial efectiva. Abstract There are many countries in Latin America whose criminal justice systems are structured in such a way that does not allow a jurisdictional trial in a significant number of criminal cases. In these systems, prevail a set of early or alternative procedures, in which the accused and the victim have little or any participation at all, of, or do not meet in disregard of the characteristics and standards of a contradictory process Despite dismissing the right to a prior proceeding, the State must ensure that those early or alternative departures meet the standards of due process, thus observing those cases in which relevant legal principles could be affected – equality of arms, the right to be heard, the right to present evidence and the right not to testify against oneself. By neglecting these rights, the State fails to fulfill its duty to guarantee the constitutional right to effective judicial protection.

The objective of this study was to characterize fruit and vegetable consumption in 9 selected countries of the World Health Organization (WHO) European Region. We analyzed data on fruit and vegetable intake and participant sociodemographic characteristics for 30,455 adults in 9 Eastern European and Central Asian countries via standardized STEPS survey methodology. Fruit and vegetable consumption across all countries was suboptimal, with a high percentage of populations not meeting the WHO-recommended intake of at least 5 servings (400 g) per day. Strengthened implementation of evidence-based policies to increase intake of fruit and vegetables is needed to reduce the burden of and disparities in NCDs.

Given a simply connected domain U ⊂ C with a piecewise Dini-smooth boundary ∂ U which admits a finite set of Dini-smooth corners of openings lying in ( 0 , 2 π ] , we study the C ∗ -algebra B U = { a I , B U , B ~ U : a ∈ X ( L ) } generated by the operators of multiplication by functions in X ( L ) , and by the Bergman projection B U and anti-Bergman projection B ~ U acting on the Lebesgue space L 2 ( U ) . The C ∗ -algebra X ( L ) is generated by all piecewise continuous functions on the closure U ¯ of U with discontinuities on a finite union L of piecewise Dini-smooth curves that have one-sided tangents at every point, do not form cusps and are not tangent to ∂ U at the points of L ∩ ∂ U , and by all bounded continuous functions on U that slowly oscillate at points of ∂ U . Making use of the Allan-Douglas local principle, the limit operators techniques and the Kehe Zhu results on the class Q = V M O ∂ ( D ) ∩ L ∞ ( D ) , a Fredholm symbol calculus for the C ∗ -algebra B U is constructed and a Fredholm criterion for the operators A ∈ B U is obtained.

Verbal autopsy (VA) is a systematic approach for determining causes of death (CoD) in populations without routine medical certification. It has mainly been used in research contexts and involved relatively lengthy interviews. Our objective here is to describe the process used to shorten, simplify, and standardise the VA process to make it feasible for application on a larger scale such as in routine civil registration and vital statistics (CRVS) systems. A literature review of existing VA instruments was undertaken. The World Health Organization (WHO) then facilitated an international consultation process to review experiences with existing VA instruments, including those from WHO, the Demographic Evaluation of Populations and their Health in Developing Countries (INDEPTH) Network, InterVA, and the Population Health Metrics Research Consortium (PHMRC). In an expert meeting, consideration was given to formulating a workable VA CoD list [with mapping to the International Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) CoD] and to the viability and utility of existing VA interview questions, with a view to undertaking systematic simplification. A revised VA CoD list was compiled enabling mapping of all ICD-10 CoD onto 62 VA cause categories, chosen on the grounds of public health significance as well as potential for ascertainment from VA. A set of 221 indicators for inclusion in the revised VA instrument was developed on the basis of accumulated experience, with appropriate skip patterns for various population sub-groups. The duration of a VA interview was reduced by about 40% with this new approach. The revised VA instrument resulting from this consultation process is presented here as a means of making it available for widespread use and evaluation. It is envisaged that this will be used in conjunction with automated models for assigning CoD from VA data, rather than involving physicians.