Biomedical subjects

Zilvinas Padaiga

Publications and source records attributed to Zilvinas Padaiga.

14 recordsLinked to original sources

PubMed2006

Higher prevalence of autoantibodies to insulin and GAD65 in Swedish compared to Lithuanian children with type 1 diabetes.

We compared the prevalence of beta-cell autoantibodies and genetic risk factors in Sweden and Lithuania. Ninety-six patients from Sweden and 96 from Lithuania matched for age and gender (1-15 years old, median age 9.0 years) were included. We analyzed autoantibodies to insulin (IAA), glutamic acid decarboxylase (GADA) and the protein tyrosine phosphatase like IA-2 (IA-2A) as well as risk-associated polymorphisms of HLA, insulin and cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) genes. The frequency of patients positive for IAA and GADA was higher in Sweden than in Lithuania (p = 0.043 and 0.032). The differences remained even when the patients were matched for HLA, insulin and CTLA-4 risk genotypes. Patients with low levels of IAA had higher levels of HbA1c and ketones at diagnosis. The frequency of the risk haplotype DR4-DQ8 was higher in Swedish than in Lithuanian patients (p = 0.004), as well as the high-risk combination of DR4-DQ8 and DR3-DQ2 haplotypes (p = 0.009). Our results suggest that autoimmune process against insulin and GAD(65) is more common at diagnosis in children in areas with high incidence of type 1 diabetes (T1D), independent of genetic risk markers. Furthermore, the disease in patients with insulin autoantibodies seems to be clinically milder.

Adolescent↗

PubMed2006

Cost-utility analysis of methadone maintenance treatment: a methodological approach.

Economic considerations influence the substance user treatment system. These considerations influence who gets treatment and for how long, as well as determining what services they receive and in what setting. Current medical literature argues that maintenance treatment reduces risk-taking behavior, such as injection drug use and needle sharing. Treatment also reduces the mortality associated with abuse of opiates by injection and can cause decreases in costs incurred by the criminal justice system and social services agencies. This suggests the need for complex economic evaluations of a maintenance treatment to find out the optimum treatment program. This paper describes methods of economic evaluation in health care and reviews the methodology of cost-utility analysis in economic evaluations of methadone maintenance treatment.

Costs and Cost Analysis↗

PubMed2005

The future prospects of Lithuanian family physicians: a 10-year forecasting study.

BACKGROUND: When health care reform was started in 1991, the physician workforce in Lithuania was dominated by specialists, and the specialty of family physician (FP) did not exist at all. During fifteen years of Lithuania's independence this specialty evolved rapidly and over 1,900 FPs were trained or retrained. Since 2003, the Lithuanian health care sector has undergone restructuring to optimize the network of health care institutions as well as the delivery of services; specific attention has been paid to the development of services provided by FPs, with more health care services shifted from the hospital level to the primary health care level. In this paper we analyze if an adequate workforce of FPs will be available in the future to take over new emerging tasks. METHODS: A computer spreadsheet simulation model was used to project the supply of FPs in 2006-2015. The supply was projected according to three scenarios, which took into account different rates of retirement, migration and drop out from training. In addition different population projections and enrollment numbers in residency programs were also considered. Three requirement scenarios were made using different approaches. In the first scenario we used the requirement estimated by a panel of experts using the Delphi technique. The second scenario was based on the number of visits to FPs in 2003 and took into account the goal to increase the number of visits. The third scenario was based on the determination that one FP should serve no more than 2,000 inhabitants. The three scenarios for the projection of supply were compared with the three requirement scenarios. RESULTS: The supply of family physicians will be higher in 2015 compared to 2005 according to all projection scenarios. The largest differences in the supply scenarios were caused by different migration rates, enrollment numbers to training programs and the retirement age. The second supply scenario, which took into account 1.1% annual migration rate, stable enrollment to residency programs and later retirement, appears to be the most probable. The first requirement scenario, which was based on the opinion of well-informed key experts in the field, appears to be the best reflection of FP requirements; however none of the supply scenarios considered would satisfy these requirements. CONCLUSION: Despite the rapid expansion of the FP workforce during the last fifteen years, ten-year forecasts of supply and requirement indicate that the number of FPs in 2015 will not be sufficient. The annual enrollment in residency training programs should be increased by at least 20% for the next three years. Accurate year-by-year monitoring of the workforce is crucial in order to prevent future shortages and to maintain the desired family physician workforce.

Adult↗

PubMed2004

[The survey of Lithuanian physicians and medical residents regarding possible migration to the European Union].

The aim of this survey was to evaluate intentions of Lithuanian physicians and medical residents to work in the European Union (EU) and other countries. The survey was performed in 2002 in the framework of the project "Health human resource development and planning in Lithuania", sponsored by Open Society Fund, Lithuania. Using the questionnaire developed by the Ministry of Labor and Solidarity of France, 242 medical residents and 497 physicians were surveyed. Survey results indicated that 60.7% of medical residents and 26.0% of physicians intended to leave for the EU or other countries. The survey also showed that the first-choice countries were United Kingdom, Germany and the Nordic countries. Almost 15.0% of medical residents and 5.0% of physicians planed to leave for the EU on permanent basis. The largest part of those who intended to leave for the EU, planned to go there after accession. It was a definitive decision of 2.5% of medical residents and 3.8% of physicians. The major reasons for leaving were higher salary, better professional possibilities and better quality of life. For medical residents a previous visit abroad for professional reasons increased the risk of working abroad significantly (OR-3.29, 95% CI 1.73-6.27). In the case of physicians, age was the factor that significantly decreased the risk (OR-0.94, 95% CI 0.91-0.96); however having friends abroad increased the risk by more than three times (OR-3.22, 95% CI 1.91-5.42). In order to observe the possible migration to the EU or other countries, the survey should be repeated every three-four years.

Adult↗

PubMed2004

Systematic review on the incidence and prevalence of severe maternal morbidity.

OBJECTIVE: To summarize the prevalence and the incidence of serious morbidity from studies reporting data on severe maternal morbidity and to compare study designs and definitions. METHODS: A literature search was used to identify relevant studies, which report data on prevalence/incidence of severe complications during pregnancy, delivery and postpartum. For assessment of the quality of studies a structured data collection form from World Health Organization for systematic review of maternal mortality and morbidity was used. Incidence/prevalence and case-fatality ratios were extracted. RESULTS: In this review 24 studies were included, most of them--cross-sectional hospital based (16/24). In ten studies data about one severe maternal condition (admissions to intensive care unit, and hysterectomy) was presented, while fourteen studies dealt with multiple causes of severe maternal morbidity (rupture of uterus, hemorrhage, sepsis, and hypertensive disorders of pregnancy). In these studies very different inclusion criteria due to structure of diseases and severity were used. CONCLUSIONS: The prevalence of severe maternal morbidity ranged from 0.07-8.23% and the case-fatality ratio from 0.02-37%. Studies estimating the incidence of severe maternal morbidity have used different definitions and ways of identification. Severe hemorrhage, sepsis and hypertensive disorders of pregnancy are the commonly used "near-miss" conditions. Further work will be able to create clear definition and method of identification.

Adult↗

PubMed2004

Maternal socio-economic factors and the risk of low birth weight in Lithuania.

AIM: To evaluate the importance of maternal socio-economic factors on the risk of low birth weight in Lithuania. MATERIAL AND METHODS: The case-control study involved 851 newborns with low birth weight (<2500 g) (cases) and 851 newborns with normal weight (controls). Study was accomplished from 1st February, 2001 until 31st October, 2002 in six main maternity hospitals in Lithuania. Mothers of infants were interviewed on the first day after delivery using the structured questionnaire. The database was processed by the application of statistical package "SPSS for Windows v.10.0". RESULTS: Young (<20 years) and older (35 years and older) maternal age, primary or basic education, being single, divorced or widowed, low income, living in rural area and unemployment before pregnancy and during pregnancy increased the risk to deliver low birth weight baby in univariate analysis. In logistic multivariable regression analysis, low education, low income and unemployment during pregnancy significantly increased risk of low birth weight--OR - 2.0, 1.7 and 1.6 respectively. Interaction between several unfavorable risk factors increased risk of low birth weight by 3.4-7.8 times, being the highest among mothers with low education, unstable marital status and low income. CONCLUSION: Maternal unfavorable socio-economic factors increased the risk to deliver low birth weight baby.

Adult↗

PubMed2004

[Economic efficiency of methadone maintenance and factors affecting it].

UNLABELLED: Methadone maintenance is effective in reducing injection drug use, needle sharing, and the overall mortality associated with opiate abuse. Scientific literature describes that efficiency of methadone maintenance program depends on many factors. Our analysis is based on description of economic research methods and on factors affecting economic efficiency of methadone maintenance. METHODS: Computerized Medline data base was searched by key words: "economic evaluation", "cost-effectiveness", "cost-utility", "methadone", "methadone dosage", "ancillary services", "treatment duration". Review and analysis. RESULTS: Methadone maintenance therapy has higher economic efficiency with 80-100 mg per day methadone dose. Doses lower than 40 mg per day are considered as inefficient. Some methadone programs limit treatment to 90 days or less, but such short treatment episodes are not likely to be cost-effective. Ancillary services are more cost-effective at the beginning of methadone maintenance program, than in the later stages of the program. Economic efficiency is higher when program involves more participants, than when more ancillary services are provided. CONCLUSIONS. Effectiveness of Methadone maintenance program affects methadone dosage policy, treatment duration and ancillary services.

Cohort Studies↗

PubMed2004

Drug addiction maintenance treatment and quality of life measurements.

Quality of life measurements are increasingly incorporated into trials of pharmaceuticals. This can be applied to a wide range of medical areas including drug-addiction maintenance treatment programs. Maintenance treatment has been demonstrated to be an effective treatment for opioid addiction but still lacks quality of life specific measures to measure the maintenance program effects and until now there have been only few attempts to assess the impact of opioid dependence and its treatment on the drug-addicted patients' quality of life. The aim of this article is to describe quality of life concept, measurement instruments, selection criteria and its applicability in the drug addiction maintenance studies.

Activities of Daily Living↗

PubMed2003

Risk factors of perinatal mortality in Lithuania, 1997-1998.

AIM: The aim of this paper is to determine the risk factors of perinatal mortality in Lithuania during 1997-1998. METHODS: The focus of the study is the 1997-1998 Medical Birth Register Database (N = 75,178) covering social-demographic factors, the obstetric anamnesis of previous pregnancies, as well as mothers health behaviour and pathology of the current pregnancy, delivery and obstetric aid. The multivariate analysis assessing odds ratios of risk factors for perinatal mortality using logistic regression has been carried out and related population attributable risk fractions were calculated. RESULTS: A statistically significant (p < 0.01) model predicting perinatal mortality has been obtained in which 19 out of 76 analysed factors have been distinguished to be statistically significant. The septic state of the mother during the delivery (OR = 13.3; CI = 8.9-19.9) and haemorrhage due to a premature placental separation (OR = 11.6; CI = 7.9-16.9) were associated with substantial increased risks of the foetus. Factors from other groups (perinatal pathology during previous pregnancies and social, behavioural or environmental factors) had somewhat lower, though significant, risk on perinatal mortality. The highest population attributable risk fraction (PARF) was found for the breech birth and foetal growth retardation (PARF = 13 percent and PARF = 9.7 percent, respectively). It should be pointed out that the impact of marital status on perinatal mortality was very high (PARF = 6.4 percent), even higher than that of some clinical factors, though its odds ratio was among the lowest (OR = 1.5; CI = 1.2-1.7). CONCLUSION: During 1997-1998, the highest risk for perinatal mortality in Lithuania was associated with obstetric aid during delivery and pathology of current pregnancy. These groups of risk factors had also the highest population attributable risk fraction.

Alcohol Drinking↗

PubMed2003

Inheritance of MHC class II genes in Lithuanian families with type 1 diabetes.

Type 1 diabetes mellitus (DM) is caused by genetic and environmental factors. Twice as many fathers as mothers of children with type 1 DM have the disease. The reason for the differences remains unclear. We looked at the transmission rates of diabetes-related alleles from parents to children with diabetes. All children with newly diagnosed type 1 DM from August 1, 1996 to August 1, 2000, aged 0 to 15 years, in Lithuania were invited to participate. Blood samples for full genetic analysis were available from 125 families. HLA DQA1, DQB1, and DRB1 typing was done on DNA extracted from peripheral blood, by polymerase chain reaction amplification, manual dot-blotting onto nylon membranes, synthetic sequence-specific oligonucleotide probe 3'-end labeling with (32)P-dCTP, and hybridization, followed by stringency washes, autoradiography, and allele calling. Frequency of diabetes risk-related alleles DQB1*0302, DQA1*0201, DR4, and DR3 was less prevalent among Lithuanian than among Swedish children with type 1 DM. Transmission rates of DR4-DQB1*0302-DQA1*0301 and DR3-DQB1*0201-DQA1*0501 haplotypes from parents were higher than expected: chi(2) (TDT) 30.56, p < 0.0001, and chi(2) (TDT) 11.26, p = 0.0008, respectively. DQB1*0302 and DR4 were significantly more frequently transmitted from both parents, but DR3 was transmitted more frequently only from mothers. Any of these alleles had similar frequencies among female and male offspring. We conclude that, besides DR4-DQB1*0302-DQA1*0301 and DR3-DQB1*0201-DQA1*0501, there are other inherited alleles that determine risk for type 1 DM among children in Lithuania. Fathers might transfer other alleles of disease susceptibility in higher frequency or mothers might provide a protective environment during pregnancy, which results in higher risk to offspring of fathers than mothers to develop diabetes.

Adolescent↗

PubMed2003

Physicians resources in Lithuania: change comes slowly.

AIM: To analyze the structure of the physician workforce in Lithuania at the time when the country gained independence, changes it has undergone since 1990, and physician resource planning activities. METHODS: National and international databases were examined to determine the changes in the structure of physician workforce after 1990. Studies and reports, funded by international and national governmental organizations, were reviewed to examine the recommendations for physician resource planning and the rate of their acceptance. Since there was no government plan, a study using Delphi technique was conducted to find consensus among practitioners and policy makers on the physician-to-population ratio needed in Lithuania. Medical residents and physicians in Lithuania were surveyed to assess their emigration intentions. RESULTS: In comparison with other Baltic countries, the number of physicians in Lithuania has remained high despite dramatic reductions in the number of students enrolled to medical schools. There is still a maldistribution of physician resources geographically and by specialty. The government has accepted few recommendations based on the international studies. None of the internal databases provided all the needed information on the physician workforce and the existing databases could not be linked to gain access to all required information. CONCLUSIONS: The physician-to-population ratio remained high after Lithuania had gained independence. There has been little planning at the government level to determine the number of physicians needed in a reformed health system. Changes in the number of students admitted to medical schools did not follow from a well thought-out long-term plan for physician workforce the country will need in the future. To develop a frequently updated database of physicians is essential for the successful planning of future physician workforce.

Databases as Topic↗

PubMed2002

[Do maternal social factors, health behavior and work conditions during pregnancy increase the risk of low birth weight in Lithuania?].

UNLABELLED: The objective of the paper was to evaluate the importance of maternal social factors, health behavior (smoking, alcohol drinking and drug abuse) and working conditions on incidence of low birth weight (LBW). MATERIAL AND METHODS: Statistical analysis was performed utilizing database of Medical Birth Registry for the years 1995-1998 using the indicators of maternal social factors, health behavior and working conditions. Statistical analysis was carried out using statistical package SPSS 10.0. RESULTS: During 1995-1998 the incidence of LBW (< 2500 g) was 3.6 per cent. Young (< 20 years) and older (> or = 35 years) maternal age, low (primary or basic) education and "lone mother" status (single, divorced or widowed) increased the risk of delivering LBW baby. The odds ratio of smoking mothers to deliver LBW baby was 3.3. Odds ratios of LBW newborns associated with alcohol drinking and drug abuse were 10.3 and 6.1 respectively. The odds ratio of mothers physically abused during pregnancy to deliver LBW baby was 2.7. However, the harmful working conditions were not associated with the higher odds of LBW. Young and older age was attributable for 22.2 and 49.3 per cent LBW cases in the exposed group respectively. While attributable fraction in exposed due to the low educational level and unfavourable marital status accounted to 38.9 and 52.9 per cent LBW cases respectively. Smoking was attributable for 68 per cent LBW cases, alcohol drinking--87.2 per cent, drug abuse--80.5 per cent LBW cases among exposed mothers. Preventable population attributable risk for unfavourable marital status was 11.7 per cent, low education--9 per cent, smoking--8 per cent, older age--6.9 per cent. Drug abuse and hard manual work had minimal association while harmful working conditions were not associated with higher risk to deliver the LBW baby in the total population. CONCLUSIONS: Maternal health behavior peculiarities and hard manual work are related to newborns' birth weight, and medical professionals should encourage quitting the hazardous habits and regulation of workload for expectant mothers. Adverse social factors contribute to the higher incidence of LBW. The solution of social problems should become the priority of State health policy.

Adult↗

PubMedDate not supplied

Longer breastfeeding is an independent protective factor against development of type 1 diabetes mellitus in childhood.

BACKGROUND: Early weaning diet, early introduction of breast milk substitution and cow's milk have been shown to increase the risk of type 1 diabetes later in life. It is also shown that older maternal age, maternal education, preeclampsia, prematurity, neonatal illness and neonatal icterus caused by blood group incompatibility, infections and stress might be risk factors for type 1 diabetes. We aimed to determine whether early nutrition is an independent risk factor for diabetes despite other life events. METHODS: Data from 517 children (268 boys and 249 girls) in south-east of Sweden and 286 children (133 boys and 153 girls) in Lithuania in the age group of 0 to 15 years with newly diagnosed type 1 diabetes mellitus were included into analysis. Three age- and sex-matched healthy controls were randomly selected. Response rate in control families in Sweden was 72.9% and in Lithuania 94.8%. Information was collected via questionnaires. RESULTS: Exclusive breastfeeding longer than five months (odds ratio 0.54, 95% confidence interval 0.36-0.81) and total breastfeeding longer than 7 (0.56, 0.38-0.84) or 9 months (0.61, 0.38-0.84), breastfeeding substitution that started later than the third month (0.57, 0.33-0.98) among Swedish children 5 to 9 years old and later than the seventh month (0.24, 0.07-0.84) among all Swedish children is protective against diabetes when adjusted for all other above-listed risk factors. In Lithuania, exclusive breastfeeding longer than two months in the age group of 5 to 9 years is protective (0.58, 0.34-0.99) when adjusted for other factors. CONCLUSIONS: Longer exclusive and total breastfeeding appears as an independent protective factor against type 1 diabetes.

Analysis of Variance↗

PubMedDate not supplied

Physician workforce planning and the transition to primary health care in former socialist countries.

With the collapse of the Soviet Union, countries in Eastern Europe and the Newly Independent States inherited a physician workforce that was often too large, dominated by specialists, and poorly prepared for the transition to primary health care and the addition of the family/general practice specialty. We examine attempts in selected countries to plan the future physician workforce, while attempting to reduce the size of the workforce and train physicians to lead the transition to primary health care (PHC). We look the impact these efforts have had on the current workforce and will have on the future physician workforce. With few exceptions, the first move after independence was to reduce the inputs into the physician workforce in an attempt to reduce the size of the workforce, considered large by western standards, in 1990 between 350 and 400 per 100, 000 population compared to the EU average of 299. These reductions often did not result from planning and ignored the lengthy physician training process, leading to concerns for the future supply of physicians and the conclusion that many other factors were influencing the number of physicians. At the same time, two methods were being employed to rapidly prepare physicians for PHC, retraining of existing physicians for the short-term and the establishment of training programs in the faculties of medicine to train family/general practitioners (GPs) for the long-term. GPs per 100,000 population remained at about 102 throughout the period in the original EU countries, but in the new EU countries went from 51 in 1991 to 63 in 2002. The success of the programs was varied and often depended on the overall organization of the physician workforce, the status of the new family physician within the workforce and the commitment at the national level to the transition to PHC. After over a decade of independence, there is still a struggle to have a physician workforce with the right numbers, the right specialty mix, and practicing in the right locations.

Education, Medical, Graduate↗