While an interleukin-1 receptor antagonist gene polymorphism (IL1RN-VNTR) has recently been hypot... more While an interleukin-1 receptor antagonist gene polymorphism (IL1RN-VNTR) has recently been hypothesized to be a risk factor for coronary artery disease, no prospective data relating this polymorphism to subsequent risk of coronary events are available. We therefore investigated the association between IL1RN-VNTR genotype and the incidence of myocardial infarction (MI) in a large, prospective cohort of initially healthy men. The IL1RN-VNTR was evaluated among 385 MI case subjects and an equal number of age- and smoking-matched control subjects during a 12-year follow-up. Overall, the allele and genotype distributions were similar among cases and controls, both in the total cohort and in all subgroups evaluated. All observed genotype frequencies were in Hardy-Weinberg equilibrium. Furthermore, the relative risk in a comparison of homozygous mutant to homozygous wild-type was 0.89 (95%CI = 0.5-1.6; P = 0.9). In this large, prospective study, the IL1RN-VNTR gene polymorphism is not ass...
Police violence against people who inject drugs (PWID) is common in Russia and associated with HI... more Police violence against people who inject drugs (PWID) is common in Russia and associated with HIV risk behaviours. Sexual violence from police against women who use drugs has been reported anecdotally in Russia. This mixed-methods study aimed to evaluate sexual violence from police against women who inject drugs via quantitative assessment of its prevalence and HIV risk correlates, and through qualitative interviews with police, substance users and their providers in St. Petersburg, Russia. Cross-sectional analyses with HIV-positive women who inject drugs (N=228) assessed the associations between sexual violence from police (i.e. having been forced to have sex with a police officer) and the following behaviours: current drug use, needle sharing and injection frequency using multiple regression models. We also conducted in-depth interviews with 23 key informants, including PWID, police, civil society organization workers, and other stakeholders, to explore qualitatively the phenomen...
Essential interventions can improve maternal and newborn health (MNH) outcomes in low- and middle... more Essential interventions can improve maternal and newborn health (MNH) outcomes in low- and middle-income countries, but their implementation has been challenging. Innovative MNH approaches have the potential to accelerate progress and to lead to better health outcomes for women and newborns, but their added value to health systems remains incompletely understood. This study's aim was to analyze the landscape of innovative MNH approaches and related published evidence. Systematic literature review and descriptive analysis based on the MNH continuum of care framework and the World Health Organization health system building blocks, analyzing the range and nature of currently published MNH approaches that are considered innovative. We used 11 databases (MedLine, Web of Science, CINAHL, Cochrane, Popline, BLDS, ELDIS, 3ie, CAB direct, WHO Global Health Library and WHOLIS) as data source and extracted data according to our study protocol. Most innovative approaches in MNH are iterations of existing interventions, modified for contexts in which they had not been applied previously. Many aim at the direct organization and delivery of maternal and newborn health services or are primarily health workforce interventions. Innovative approaches also include health technologies, interventions based on community ownership and participation, and novel models of financing and policy making. Rigorous randomized trials to assess innovative MNH approaches are rare; most evaluations are smaller pilot studies. Few studies assessed intervention effects on health outcomes or focused on equity in health care delivery. Future implementation and evaluation efforts need to assess innovations' effects on health outcomes and provide evidence on potential for scale-up, considering cost, feasibility, appropriateness, and acceptability. Measuring equity is an important aspect to identify and target population groups at risk of service inequity. Innovative MNH interventions will need innovative implementation, evaluation and scale-up strategies for their sustainable integration into health systems.
The 2004 terror attack on a school in Beslan, North Caucasus, with more than 1300 children and th... more The 2004 terror attack on a school in Beslan, North Caucasus, with more than 1300 children and their families taken hostage and 334 people killed, ended after extreme violence. Following the disaster, many survivors with blast ear injuries developed complications because no microsurgery services were available in the region. Here, we present our strategies in North Ossetia to strengthen subspecialty surgical care in a region of instable security conditions. Disaster modifies disease burden in an environment of conflict-related health-care limitations. We built on available secondary care and partnered international with local stakeholders to reach and treat victims of a humanitarian disaster. A strategy of mutual commitment resulted in treatment of all consenting Beslan victims with blast trauma sequelae and of non disaster-related patients.
Collaborations for global surgery face many challenges to achieve fair and safe patient care and ... more Collaborations for global surgery face many challenges to achieve fair and safe patient care and to build sustainable capacity. The 2004 terrorist attack on a school in Beslan in North Ossetia in the Russian North Caucasus left many victims with complex otologic barotrauma. In response, we implemented a global surgery partnership between the Vladikavkaz Children's Hospital, international surgical teams, the North Ossetian Health Ministry, and civil society organizations. This study's aim was to describe the implementation and 5-year results of capacity building for complex surgery in a postconflict, mid-income setting. We conducted an observational study at the Children's Hospital in Vladikavkaz in the autonomous Republic of North Ossetia-Alania, part of the Russian Federation. We assessed the outcomes of 15 initial patients who received otologic surgeries for complex barotrauma resulting from the Beslan terrorism attack and for other indications, and report the incidenc...
In the Russian Federation (Russia), an elevated burden of premature mortality attributable to non... more In the Russian Federation (Russia), an elevated burden of premature mortality attributable to non-communicable diseases (NCDs) has been observed since the country's economic transition. NCDs are largely related to preventable risk factors such as unhealthy diets. This health policy study's aim was to analyze past and current food production and nutritional trends in Russia and their policy implications for Russia's NCD burden. We examined food security and nutrition in Russia using an analytical framework of food availability, access to food, and consumption. Agricultural production declined during the period of economic transition, and nutritional habits changed from high-fat animal products to starches. However, per-capita energy consumption remained stable due to increased private expenditures on food and use of private land. Paradoxically, the prevalence of obesity still increased because of an excess consumption of unsaturated fat, sugar, and salt on one side, and insufficient intake of fruit and vegetables on the other. Policy and economic reforms in Russia were not accompanied by a food security crisis or macronutrient deprivation of the population. Yet, unhealthy diets in contemporary Russia contribute to the burden of NCDs and related avoidable mortality. Food and nutrition policies in Russia need to specifically address nutritional shortcomings and food-insecure vulnerable populations. Appropriate, evidence-informed food and nutrition policies might help address Russia's burden of NCDs on a population level.
Violent trauma does not only affect conflict and post conflict regions, but increasingly industri... more Violent trauma does not only affect conflict and post conflict regions, but increasingly industrialized nations afflicted by violence from terror attacks. We conducted a comparative health systems analysis, assuming that that health systems with various backgrounds might learn from each other's health systems challenges caused by violent trauma. During the tragedy of Beslan in the Russian North Caucasus in September of 2004, more than 1000 children with their families were taken hostage in a school. Over three days, 334 people were killed and many more injured. While immediate trauma care was offered to all victims, many suffered from more complex injuries or from blast injuries to the ear caused by indoor bomb explosions, which were left untreated due to the lack of regional capacity for the required specialized microsurgery. Most if not all victims suffered from mental trauma as a consequence of violence, which also impacted surgical care-seeking. In April of 2013, two improvi...
Background: Years after the terror attack on a school in Beslan, North Ossetia, Russian Federatio... more Background: Years after the terror attack on a school in Beslan, North Ossetia, Russian Federation, where more than 1,000 children with their families were taken hostage and 334 people killed, many survivors with complex blast ear injuries were left untreated, because no microsurgery services were available in the North Caucasus region. Our initial approach of treating victims abroad was costly and not sustainable. Aim and Method: Building on available structures and partnering international volunteers with local medical professionals, regional government, and academic institutions, in cooperation with victims' representatives and citizen groups, we created a partnership in North Ossetia to establish microsurgery services in a highly politicized environment. Results: At the Children's Hospital in Vladikavkaz, North Ossetia, local surgeons were trained in microsurgery, and all victims with ear trauma were successfully treated without adverse events. Our concerted strategy hel...
objectives To review medical devices addressing newborn health in resource-poor settings, and to ... more objectives To review medical devices addressing newborn health in resource-poor settings, and to identify existing and potential barriers to their actual and efficient use in these settings.
doses of a much older therapeutic strategy, that of RAAS blockade, in addition to background cont... more doses of a much older therapeutic strategy, that of RAAS blockade, in addition to background contemporary practice for chronic heart failure (excepting ACE inhibitors). In the absence of effi cacious novel agents, we clearly need to focus on improving the therapeutic use of existing drugs. HEAAL reminds us that much still needs to be learned in this area, specifi cally a renewed focus on seeking the optimum dose of such agents in patients with chronic heart failure.
The 2004 terror attack on a school in Beslan, North Caucasus, with more than 1300 children and th... more The 2004 terror attack on a school in Beslan, North Caucasus, with more than 1300 children and their families taken hostage and 334 people killed, ended after extreme violence. Following the disaster, many survivors with blast ear injuries developed complications because no microsurgery services were available in the region. Here, we present our strategies in North Ossetia to strengthen subspecialty surgical care in a region of instable security conditions. Disaster modifies disease burden in an environment of conflict-related health-care limitations. We built on available secondary care and partnered international with local stakeholders to reach and treat victims of a humanitarian disaster. A strategy of mutual commitment resulted in treatment of all consenting Beslan victims with blast trauma sequelae and of non disaster-related patients.
Background: The Russian Federation (Russia) has one of the highest smoking rates in the world. Th... more Background: The Russian Federation (Russia) has one of the highest smoking rates in the world. The purpose of this study is to analyze past and current trends of the tobacco epidemic in the Russian Federation, review current tobacco control policy responses, and identify areas of opportunity for policy priorities.
Background: To provide evidence on the global epidemiological situation of neonatal hypothermia a... more Background: To provide evidence on the global epidemiological situation of neonatal hypothermia and to provide recommendations for future policy and research directions.
Nondisclosure of one's HIV infection to sexual partners obviates safer sex negotiations and thus ... more Nondisclosure of one's HIV infection to sexual partners obviates safer sex negotiations and thus jeopardizes HIV transmission prevention. The role of alcohol use in the disclosure decision process is largely unexplored. This study assessed the association between alcohol use and recent nondisclosure of HIV serostatus to sex partners by HIVinfected risky drinkers in St. Petersburg, Russia. Approximately half (317/605; 52.4 %) reported not having disclosed their HIV serostatus to all partners since awareness of infection. Using three separate GEE logistic regression models, we found no significant association between alcohol dependence, risky alcohol use (past 30 days), or alcohol use at time of sex (past 30 days) with recent (past 3 months) enfermedades de transmisión sexual. La falta de comunicación del diagnóstico de VIH a parejas sexuales es común entre infectados por el VIH en Rusia, pero el consumo de alcohol no parece ser un predictor.
While an interleukin-1 receptor antagonist gene polymorphism (IL1RN-VNTR) has recently been hypot... more While an interleukin-1 receptor antagonist gene polymorphism (IL1RN-VNTR) has recently been hypothesized to be a risk factor for coronary artery disease, no prospective data relating this polymorphism to subsequent risk of coronary events are available. We therefore investigated the association between IL1RN-VNTR genotype and the incidence of myocardial infarction (MI) in a large, prospective cohort of initially healthy men. The IL1RN-VNTR was evaluated among 385 MI case subjects and an equal number of age- and smoking-matched control subjects during a 12-year follow-up. Overall, the allele and genotype distributions were similar among cases and controls, both in the total cohort and in all subgroups evaluated. All observed genotype frequencies were in Hardy-Weinberg equilibrium. Furthermore, the relative risk in a comparison of homozygous mutant to homozygous wild-type was 0.89 (95%CI = 0.5-1.6; P = 0.9). In this large, prospective study, the IL1RN-VNTR gene polymorphism is not ass...
Police violence against people who inject drugs (PWID) is common in Russia and associated with HI... more Police violence against people who inject drugs (PWID) is common in Russia and associated with HIV risk behaviours. Sexual violence from police against women who use drugs has been reported anecdotally in Russia. This mixed-methods study aimed to evaluate sexual violence from police against women who inject drugs via quantitative assessment of its prevalence and HIV risk correlates, and through qualitative interviews with police, substance users and their providers in St. Petersburg, Russia. Cross-sectional analyses with HIV-positive women who inject drugs (N=228) assessed the associations between sexual violence from police (i.e. having been forced to have sex with a police officer) and the following behaviours: current drug use, needle sharing and injection frequency using multiple regression models. We also conducted in-depth interviews with 23 key informants, including PWID, police, civil society organization workers, and other stakeholders, to explore qualitatively the phenomen...
Essential interventions can improve maternal and newborn health (MNH) outcomes in low- and middle... more Essential interventions can improve maternal and newborn health (MNH) outcomes in low- and middle-income countries, but their implementation has been challenging. Innovative MNH approaches have the potential to accelerate progress and to lead to better health outcomes for women and newborns, but their added value to health systems remains incompletely understood. This study's aim was to analyze the landscape of innovative MNH approaches and related published evidence. Systematic literature review and descriptive analysis based on the MNH continuum of care framework and the World Health Organization health system building blocks, analyzing the range and nature of currently published MNH approaches that are considered innovative. We used 11 databases (MedLine, Web of Science, CINAHL, Cochrane, Popline, BLDS, ELDIS, 3ie, CAB direct, WHO Global Health Library and WHOLIS) as data source and extracted data according to our study protocol. Most innovative approaches in MNH are iterations of existing interventions, modified for contexts in which they had not been applied previously. Many aim at the direct organization and delivery of maternal and newborn health services or are primarily health workforce interventions. Innovative approaches also include health technologies, interventions based on community ownership and participation, and novel models of financing and policy making. Rigorous randomized trials to assess innovative MNH approaches are rare; most evaluations are smaller pilot studies. Few studies assessed intervention effects on health outcomes or focused on equity in health care delivery. Future implementation and evaluation efforts need to assess innovations' effects on health outcomes and provide evidence on potential for scale-up, considering cost, feasibility, appropriateness, and acceptability. Measuring equity is an important aspect to identify and target population groups at risk of service inequity. Innovative MNH interventions will need innovative implementation, evaluation and scale-up strategies for their sustainable integration into health systems.
The 2004 terror attack on a school in Beslan, North Caucasus, with more than 1300 children and th... more The 2004 terror attack on a school in Beslan, North Caucasus, with more than 1300 children and their families taken hostage and 334 people killed, ended after extreme violence. Following the disaster, many survivors with blast ear injuries developed complications because no microsurgery services were available in the region. Here, we present our strategies in North Ossetia to strengthen subspecialty surgical care in a region of instable security conditions. Disaster modifies disease burden in an environment of conflict-related health-care limitations. We built on available secondary care and partnered international with local stakeholders to reach and treat victims of a humanitarian disaster. A strategy of mutual commitment resulted in treatment of all consenting Beslan victims with blast trauma sequelae and of non disaster-related patients.
Collaborations for global surgery face many challenges to achieve fair and safe patient care and ... more Collaborations for global surgery face many challenges to achieve fair and safe patient care and to build sustainable capacity. The 2004 terrorist attack on a school in Beslan in North Ossetia in the Russian North Caucasus left many victims with complex otologic barotrauma. In response, we implemented a global surgery partnership between the Vladikavkaz Children's Hospital, international surgical teams, the North Ossetian Health Ministry, and civil society organizations. This study's aim was to describe the implementation and 5-year results of capacity building for complex surgery in a postconflict, mid-income setting. We conducted an observational study at the Children's Hospital in Vladikavkaz in the autonomous Republic of North Ossetia-Alania, part of the Russian Federation. We assessed the outcomes of 15 initial patients who received otologic surgeries for complex barotrauma resulting from the Beslan terrorism attack and for other indications, and report the incidenc...
In the Russian Federation (Russia), an elevated burden of premature mortality attributable to non... more In the Russian Federation (Russia), an elevated burden of premature mortality attributable to non-communicable diseases (NCDs) has been observed since the country's economic transition. NCDs are largely related to preventable risk factors such as unhealthy diets. This health policy study's aim was to analyze past and current food production and nutritional trends in Russia and their policy implications for Russia's NCD burden. We examined food security and nutrition in Russia using an analytical framework of food availability, access to food, and consumption. Agricultural production declined during the period of economic transition, and nutritional habits changed from high-fat animal products to starches. However, per-capita energy consumption remained stable due to increased private expenditures on food and use of private land. Paradoxically, the prevalence of obesity still increased because of an excess consumption of unsaturated fat, sugar, and salt on one side, and insufficient intake of fruit and vegetables on the other. Policy and economic reforms in Russia were not accompanied by a food security crisis or macronutrient deprivation of the population. Yet, unhealthy diets in contemporary Russia contribute to the burden of NCDs and related avoidable mortality. Food and nutrition policies in Russia need to specifically address nutritional shortcomings and food-insecure vulnerable populations. Appropriate, evidence-informed food and nutrition policies might help address Russia's burden of NCDs on a population level.
Violent trauma does not only affect conflict and post conflict regions, but increasingly industri... more Violent trauma does not only affect conflict and post conflict regions, but increasingly industrialized nations afflicted by violence from terror attacks. We conducted a comparative health systems analysis, assuming that that health systems with various backgrounds might learn from each other's health systems challenges caused by violent trauma. During the tragedy of Beslan in the Russian North Caucasus in September of 2004, more than 1000 children with their families were taken hostage in a school. Over three days, 334 people were killed and many more injured. While immediate trauma care was offered to all victims, many suffered from more complex injuries or from blast injuries to the ear caused by indoor bomb explosions, which were left untreated due to the lack of regional capacity for the required specialized microsurgery. Most if not all victims suffered from mental trauma as a consequence of violence, which also impacted surgical care-seeking. In April of 2013, two improvi...
Background: Years after the terror attack on a school in Beslan, North Ossetia, Russian Federatio... more Background: Years after the terror attack on a school in Beslan, North Ossetia, Russian Federation, where more than 1,000 children with their families were taken hostage and 334 people killed, many survivors with complex blast ear injuries were left untreated, because no microsurgery services were available in the North Caucasus region. Our initial approach of treating victims abroad was costly and not sustainable. Aim and Method: Building on available structures and partnering international volunteers with local medical professionals, regional government, and academic institutions, in cooperation with victims' representatives and citizen groups, we created a partnership in North Ossetia to establish microsurgery services in a highly politicized environment. Results: At the Children's Hospital in Vladikavkaz, North Ossetia, local surgeons were trained in microsurgery, and all victims with ear trauma were successfully treated without adverse events. Our concerted strategy hel...
objectives To review medical devices addressing newborn health in resource-poor settings, and to ... more objectives To review medical devices addressing newborn health in resource-poor settings, and to identify existing and potential barriers to their actual and efficient use in these settings.
doses of a much older therapeutic strategy, that of RAAS blockade, in addition to background cont... more doses of a much older therapeutic strategy, that of RAAS blockade, in addition to background contemporary practice for chronic heart failure (excepting ACE inhibitors). In the absence of effi cacious novel agents, we clearly need to focus on improving the therapeutic use of existing drugs. HEAAL reminds us that much still needs to be learned in this area, specifi cally a renewed focus on seeking the optimum dose of such agents in patients with chronic heart failure.
The 2004 terror attack on a school in Beslan, North Caucasus, with more than 1300 children and th... more The 2004 terror attack on a school in Beslan, North Caucasus, with more than 1300 children and their families taken hostage and 334 people killed, ended after extreme violence. Following the disaster, many survivors with blast ear injuries developed complications because no microsurgery services were available in the region. Here, we present our strategies in North Ossetia to strengthen subspecialty surgical care in a region of instable security conditions. Disaster modifies disease burden in an environment of conflict-related health-care limitations. We built on available secondary care and partnered international with local stakeholders to reach and treat victims of a humanitarian disaster. A strategy of mutual commitment resulted in treatment of all consenting Beslan victims with blast trauma sequelae and of non disaster-related patients.
Background: The Russian Federation (Russia) has one of the highest smoking rates in the world. Th... more Background: The Russian Federation (Russia) has one of the highest smoking rates in the world. The purpose of this study is to analyze past and current trends of the tobacco epidemic in the Russian Federation, review current tobacco control policy responses, and identify areas of opportunity for policy priorities.
Background: To provide evidence on the global epidemiological situation of neonatal hypothermia a... more Background: To provide evidence on the global epidemiological situation of neonatal hypothermia and to provide recommendations for future policy and research directions.
Nondisclosure of one's HIV infection to sexual partners obviates safer sex negotiations and thus ... more Nondisclosure of one's HIV infection to sexual partners obviates safer sex negotiations and thus jeopardizes HIV transmission prevention. The role of alcohol use in the disclosure decision process is largely unexplored. This study assessed the association between alcohol use and recent nondisclosure of HIV serostatus to sex partners by HIVinfected risky drinkers in St. Petersburg, Russia. Approximately half (317/605; 52.4 %) reported not having disclosed their HIV serostatus to all partners since awareness of infection. Using three separate GEE logistic regression models, we found no significant association between alcohol dependence, risky alcohol use (past 30 days), or alcohol use at time of sex (past 30 days) with recent (past 3 months) enfermedades de transmisión sexual. La falta de comunicación del diagnóstico de VIH a parejas sexuales es común entre infectados por el VIH en Rusia, pero el consumo de alcohol no parece ser un predictor.
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Papers by Karsten Lunze