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PubMed1996

Induced abortions and childbirths: trends in Estonia, Latvia, Lithuania, Russia, Belarussia and the Ukraine during 1970 to 1994.

BACKGROUND: To analyse trends in childbirth, induced abortions and maternal morbidity from 1970 to 1994 in Estonia, Latvia, Lithuania, Russia, Belarussia and the Ukraine. METHODS: Official health statistics from the six countries were compiled and analysed. RESULTS: High abortion rates (up to 142 per 1000 women of fertile ages and years) were seen in all countries analysed, but since 1980 a continuing decrease is noted for Estonia, Latvia and Kalimingrad with a lowest rate of 50 abortions/1000 women/year in Latvia in 1994. Teenage abortions and childbirths are increasing. Maternal mortality, including complications of abortions, is still a reality in all the countries studied. CONCLUSION: The high abortion frequencies in all countries studied here indicate that national abortion prevention programs are needed. Such programs should focus on education, both of medical professionals, teenagers, fertile women and males. Concomitantly, the availability of cheap and modern contraceptives must increase, especially to defined risk groups.

Abortion, Induced↗

PubMed2001

Occupational exposure to carcinogens in Estonia, Latvia, Lithuania and the Czech Republic in 1997.

OBJECTIVES: The aim of the study was to estimate the numbers of workers exposed to carcinogens in Estonia, Latvia, Lithuania, and the Czech Republic. METHODS: CAREX is an international information system on occupational exposure to 139 known and suspected carcinogens. It provides exposure data and estimates of the numbers of exposed workers by country, carcinogen, and industry. The CAREX method, which has been previously applied in the member states of the European Union, was applied in the present study to the exposure situation in Estonia, Latvia, Lithuania, and the Czech Republic in 1997. The preliminary estimates generated by CAREX were reviewed and revised by national experts mainly for asbestos, benzene, and lead, which were of special interest for this project. RESULTS: The numbers of workers exposed to carcinogens covered by CAREX in 1997 were about 180,000 (29% of employed persons) in Estonia, 260,000 (28% of employed persons) in Latvia, 470,000 (28% of employed persons) in Lithuania, and 1,400,000 (28% of employed persons) in the Czech Republic. The most common exposures were solar radiation (7-13% exposed at least 75% of the worktime), environmental tobacco smoke (4-5% exposed at least 75% of the worktime), wood dust (3-5% exposed), crystalline silica (2-3% exposed), diesel exhaust (2-3% exposed), radon and its decay products (2% exposed), benzene (0.9-1.7% exposed), and lead and inorganic lead compounds (0.8-1.4% exposed). Exposure to asbestos was slightly less prevalent (0.3-1.1% exposed). CONCLUSIONS: These preliminary results indicate that a substantial proportion of the workers in the studied countries were exposed to carcinogens.

Carcinogens, Environmental↗

PubMed1999

Newborn screening for PKU and congenital hypothyroidism in Latvia.

The newborn screening program in Latvia was started in 1980 as pilot study project. Mass screening for phenylketonuria (PKU) in the whole republic was started in 1987, but for congenital hypothyroidism (CH) it begun in 1996. Last two years the Latvian State Medical Genetics Center (SMGC) screened nearly 25,000 newborn dried blood specimens per year. Approximately 25% are repeat and control specimens. Efficiency of the screening program is nearly 97%. Fluorometric method is used for PKU screening, followed by amino acid analysis (HPLC) and analysis of DNA samples for mutations of the PAH gene. Most of the 51 Latvian PKU patients detected from 1980 to 1998 were selected by neonatal screening (38), while the others (13) were diagnosed during genetic counseling. The incidence of PKU in Latvia is 1:8,700 births. CH screening is based on measurement of thyroid stimulating hormone (TSH), using fluoroimmunoassay method, with cut-off value 10 mlU/l, as the primary screening test, and T3 and T4, as confirmatory tests for diagnosis. From 38,684 newborns 37,380 were screened for CH in 1996 and 1997. From these 1,438 (3.8%) newborns were recalled because of initial elevation of TSH level. From these 85 (0.2%) newborns had elevated TSH level during first two weeks of life and were referred to SMGC for repeat testing and follow-up. The diagnosis of CH has been confirmed in 6 babies. The incidence of CH in Latvia is about 1:6,450.

Congenital Hypothyroidism↗

PubMed2001

Water-quality changes in Latvia and Riga 1980-2000: possibilities and problems.

Long-term changes in the environmental quality of water in Latvia (chemical composition of inland waters, wastewater treatment, and drinking-water treatment practices and quality) as a response to socioeconomic changes have been studied. Water composition, the major factors influencing water chemistry, and human impacts (wastewater loading) were studied to determine changes that occurred after recent reductions in pollution emissions, particularly nutrient loading, to surface waters. After 1991, (Latvia regained independence in 1991) inland water quality has begun to improve mainly as a result of decreases in nutrient loads from point and nonpoint sources and substantial efforts in the area of environmental protection. The situation differs, however, for drinking-water treatment, where practices have also changed during the whole period from 1980 till 2000. More stringent drinking-water-quality standards and novel insights regarding changes in water quality in the distribution network, necessitate further improvements in public water supply, and place this particular water issue among Latvia's main priorities.

Environmental Monitoring↗

PubMed2003

Self-reported suicidal and help seeking behaviours in the general population in Latvia.

BACKGROUND: The aims of this study were to assess the prevalence of suicidal behaviours in the general population in Latvia, to identify risk groups for suicidal behaviour, to examine a possible continuous sequence of suicidal behaviours with underlying gradient of severity, to assess patterns of help seeking behaviours and preferences of different types of services for suicidal persons. METHOD: A postal survey of a stratified proportional sample of the general population aged 18 and older was carried out. RESULTS: The last year and lifetime prevalence of any type of suicidal behaviours was 52.6 and 60.2 %. The incidence of self-reported suicide attempts was 1.8 and 5.1 %, respectively. Females reported significantly less serious types (includes ideation, plans and/or attempts) of suicidal behaviours (OR 0.04, p = 0.001) during last year than males. Younger age, lower level of education, urban residency and Latvian ethnicity were identified as risk factors for serious types of suicidal behaviours in both genders. Non-cohabitation status (OR 5.3, p = 0.01) and lower level of education for males, but higher levels of education for females were identified as significant risk factors for mild types (solely life-weariness and/or death wishes) of suicidal behaviours. The results indicated no simple cumulative relationship between the suicidal behaviours. Age, gender, previous help seeking experience and severity of self-reported suicidal behaviours influenced help seeking behaviours. The overall acceptance of professional services was high, but people who reported suicidal behaviours ranked them lower. CONCLUSIONS: A postal survey can provide a reasonable coverage of suicidal behaviours and description of risk groups in the general population. Higher prevalence of suicidal behaviours among males might indicate that nowadays males are under certain stress in Latvia.

Adolescent↗

PubMed2005

High prevalence of two BRCA1 mutations, 4154delA and 5382insC, in Latvia.

Our aim was to characterise the germline BRCA1 mutation profile in Latvian breast cancer and ovarian cancer patients, to develop an effective BRCA1 gene mutation detection strategy, and to document genotype-phenotype correlations in mutation carriers. The entire BRCA1 gene was analysed in 75 breast cancer and 30 ovarian cancer patients. Screening for three mutations (5382insC, 4154delA and 300T>G) was carried out in 55 breast cancer and 66 ovarian cancer patients, and for two mutations, 5382insC and 4154delA, in 376 unselected patients with any cancer (including 51 breast cancer and 29 ovarian cancers) and 215 women with any gynaecological tumour. Mutation detection techniques used were SSCP/HD analysis or F-SSCP (ABI PRISM 310). Five different deleterious mutations were detected by analysis of the entire BRCA1 gene. The proportion of cases with mutations amongst 50 breast cancer patients diagnosed before 48 years was 26.0% (95% CI: 14.6-40.3%). Two mutations (5382insC and 4154delA) made up more than 80% of all mutations identified by the analysis of the entire BRCA1 gene in Latvia, at present. Further screening for only the prevalent mutations in different cancer patient groups resulted in the identification of 53 more mutation carriers. We conclude that breast cancer diagnosed before the age of 48 years and ovarian cancer before 65 years are criteria for DNA testing to be offered to women in Latvia, regardless of cancer history in the family. The observed associations of specific prevalent mutations with cancer site and age at onset of disease are discussed.

Adult↗

PubMed2003

The unfortunate generation: stroke survivors in Riga, Latvia.

The poor health status of citizens in post-Soviet states has been reported but few studies have investigated the illness experiences of people in those countries. This paper reports findings from an interview study conducted with stroke patients in Riga, Latvia, who were part of a cohort recruited over 1 year for a European study comparing the provision of care, outcomes and resource use. The interview study aimed to elicit stroke patients' own perceptions of the impact of stroke 1 year after the event. Adopting a phenomenological perspective we illustrate how the particular social setting shapes stroke as an illness, its influences on access to health care and on consideration of the impact of stroke. We argue that for stroke survivors and their relatives in post-Soviet Latvia this disorder acquires a meaning that transcends the individual biography and signifies an upheaval of social life in general. The meanings attributed to stroke by interviewees are developed in the context of the momentous recent historical events which participants lived through. In this sense, stroke has become an idiom of a disruption in social biography rather than individual biography alone. Most participants were pensioners and their main concern was their own poverty. Some complained of their inability to meet their basic needs, much less pay for on-going medication and therapy. Only one person was 'severely disabled', using a standard neurological definition, but about half of those interviewed regarded the stroke as a sign foretelling their own death. Although this generation had expected to be cared for in their older age under the Soviet regime, the much longed for Latvian independence was seen to have brought unexpected hardships for those who were old and sick.

Activities of Daily Living↗

PubMed2001

Major demographic, social and economic factors associated to suicide rates in Latvia 1980-98.

OBJECTIVE: The aim of this study is to analyse the dynamics of suicide rates in Latvia 1980-98, when dramatic social and economical changes took place. Special attention is given to demographic risk groups and major socioeconomic correlates influencing the dynamics of suicide rates. METHOD: Descriptive statistics of suicide rates and major social and economical correlates. RESULTS: During 1980-98 there were rapid swings of suicide rates. The increase was generated mainly by males reaching a maximum of 72 per 100 000 population in 1993. The sudden drop in gross domestic product, the rapid increase in first-time alcohol psychosis and the percentage of people unemployed did not correspond strictly with the dynamics of suicide rates. CONCLUSION: Demographic and socioeconomic factors could not explain sufficiently the rapid changes in suicide rates in Latvia during the years 1980-98; psychological factors also have to be considered.

Adult↗

PubMed2006

Newborn thyrotropin screening confirms iodine deficiency in Latvia.

OBJECTIVE AND SETTING: The national neonatal thyrotropin (TSH) screening data for 2000-2002 were analysed to assess the extent and severity of iodine deficiency in Latvia. RESULTS: Elevated newborn TSH (>5 mIU/l) decreased from 16.5 to 10.4% and 8.4% in 2000, 2001 and 2002, respectively. For each year and in all regions, the prevalence of elevated newborn TSH was above the cut-off level indicative for a public health problem. A positive correlation (r=0.82, P<0.05) existed between elevated newborn TSH and low urinary iodine excretion among a nationwide sample of school children in 2000. CONCLUSION: Latvia is iodine deficient, putting each new generation at risk of preventable brain damage.

Biomarkers↗

PubMed2005

Hypertension in Latvia--epidemiology and management.

The aims of investigations were to assess the prevalence of arterial hypertension (AH) among Latvian population aged > or = 45 years and to evaluate the current AH management situation in Latvia. Four epidemiological databases (Dbases) for analyses were selected: Dbases of a randomized urban population of Riga city (in 1997) and Kuldiga region (in 2000), a Dbase of the DIASCREEN population selected by high risk to diabetes from those visiting family doctors (in 2003) and a Dbase of a Latvian population selected from those visiting family doctors during 3 days in 2005. The prevalence of AH in the urban population was 41.8 +/- 1.4% (with 61.2% for persons over age 45), in rural population 40.5 +/- 1.6% (with 63.7% for those aged above 45). Therapeutic control of AH for patients over 45 years with regular medicine intake differed significantly in three samples of the population analysed: Riga 7.2 +/- 2.7%, Kuldiga 9.9 +/- 1.6% and DIASCREEN 6.4 +/- 0.8%. The addition of another risk factor decreases the control rate, especially in a combination of AH and overweight. The most widely prescribed drugs are angiotensin-converting enzyme inhibitors (ACEI) 31%, diuretics 21% and beta-blockers 20% of patients. AH control rate in the case of monotherapy with ACEI was 6.9 +/- 0.9%, calcium antagonists 5.6+1.2%, beta-blockers 12.5+2.0% and diuretics 3.8+1.4%. The current status of management of hypertension in Latvia is discussed.

Adrenergic beta-Antagonists↗

PubMed2005

Knowledge and attitudes about abortion legislation and abortion methods among abortion clients in Latvia.

OBJECTIVE: To assess knowledge of abortion legislation and knowledge and attitudes about medical and surgical abortion among women seeking a legal abortion in Latvia. METHODS: Data are drawn from a survey of 371 abortion clients from 16 purposively selected abortion clinics in Latvia. A semi-structured questionnaire was used to collect socio-demographic data and information on women's knowledge of and attitudes toward abortion law and abortion methods. RESULTS: Most women knew that abortion is legal either under any (53%) or certain (37%) circumstances. Almost one third (31%) of women interviewed were aware of medical abortion. After hearing a description of medical abortion, respondents felt the method as described would be advantageous because it could avoid a surgical intervention (33%) or found it simple, easy, convenient, or natural (12%). Women were concerned that the method might not be completely effective (38%) or be associated with side-effects (22%). CONCLUSIONS: Respondents were interested in medical abortion as a less invasive option to surgical abortion. Efforts should be undertaken to inform women about the safety and efficacy of the method.

Abortion, Induced↗

PubMed2006

Audit of perinatal deaths in a tertiary level hospital in Latvia (1995-1999) using the Nordic-Baltic perinatal death classification: evidence of suboptimal care.

OBJECTIVE: The objective of this study was to explore applicability of the Nordic-Baltic perinatal death (PND) classification in a single hospital via evaluation of changes of the preventability of PND over the time period in a tertiary level perinatal care center in Latvia. METHOD: All PND cases during the period 1995-1999 at a tertiary referral perinatal care center, the Riga Maternity Hospital (RMH), were analyzed using the common Nordic-Baltic PND classification. RESULTS: The total perinatal mortality rate (PNMR) did not decline at the RMH over the study period. The rate of antenatal and intrapartum deaths at <28 weeks of gestation increased (p < 0.01). Early neonatal deaths at 28-33 weeks of gestation with a low 5-minute Apgar score became less frequent (p < 0.05). There was a trend towards more cases of probably suboptimal care (p < 0.005) and the proportion of preventable PND cases increased from 14.7% in 1995 to 36.4% in 1999 (p = 0.01). CONCLUSION: The perinatal audit performed at the RMH using the Nordic-Baltic PND classification disclosed a requirement for further improvement of perinatal care in the hospital. The classification can be used to evaluate the preventability of perinatal death cases in a single hospital, and its application in other hospitals in Latvia could provide information necessary for the improvement of perinatal care in the country.

Apgar Score↗

PubMed1999

An HIV type 1 subtype A outbreak among injecting drug users in Latvia.

Local, explosive outbreaks of HIV-1 infections among intravenous drug users (IDUs) caused by closely related variants have been reported in the Ukraine and Russia since 1996. Latvia experienced the start of a similar outbreak at the end of 1997 and already at the end of 1998 IDUs constituted approximately 50% of all known HIV cases (122 of 251). To investigate the molecular epidemiology of HIV-1 variants circulating among Latvian IDUs the V3 domain of the env gene was directly sequenced from samples of seven recently infected IDUs. Phylogenetic tree analysis showed that the seven Latvian HIV-1 variants had closely related subtype A genotypes that shared recent ancestry with each other as well as with variants involved in outbreaks in the Ukraine and southern Russia. There exists a clear risk for continued spread of HIV-1 in Latvia because the number of IDUs is increasing and needle sharing is common.

Adult↗

PubMed2003

Orthodontic treatment need in Latvia.

Measuring the prevalence of malocclusion and treatment need in a population is useful for the planning of orthodontic services. In addition, knowledge concerning the attitudes of patients to malocclusion is becoming increasingly important in orthodontics. Without a satisfactory estimate of the need and demand for treatment it is difficult to develop and organize a meaningful service. The aims of this investigation were to estimate the need for orthodontic treatment in 12-13-year-old school children in urban and rural schools in Latvia. Five hundred and four school children aged 12-13 years were examined using the Index of Complexity, Outcome and Need (ICON). The children were invited to complete a questionnaire about treatment need and their appearance. The survey was carried out in four urban and five rural school settings. There were no statistically significant differences in treatment need between rural and urban settings or between boys and girls. However, there was a difference in ICON scores between Riga and Daugavpils, with a greater need for treatment in Daugavpils. Individual responses to questionnaires illustrated a correlation between individuals who expressed dissatisfaction with the arrangement of their teeth and treatment need according to the ICON score. The overall prevalence of individuals needing orthodontic treatment in Latvia was 35.3 per cent, but this figure masked considerable variation between schools. For example, a greater need was found in Daugavpils than in Riga. This difference is not fully explained but could be due to genetics, the individuals in Daugavpils being mainly of Russian origin. The individuals' perception of the arrangement of teeth and the need for treatment correlated significantly with the ICON score.

Adolescent↗

PubMed2006

Health check for Latvia: opportunities for information professionals in a new democracy.

BACKGROUND: This paper outlines developments in medical information in Latvia since independence from the former USSR in 1991, and analyses the health information gap faced by professionals. OBJECTIVES: To explore international initiatives and co-operation in health information provision in Latvia; to describe the activities of Latvian medical librarians at national, regional and international level; to look at health information provision by specialist information centres; and to discuss the role of librarians in health information provision in public libraries. METHODS: An extensive search was made of databases and medical library and health information centre staff were interviewed; a questionnaire survey of librarians was carried out. RESULTS: International initiatives and co-operation by medical librarians have extended their services at national, regional and international level. Health information portals exist, with online contacts and links to smaller health centres and organizations, but rarely employ qualified librarians or information professionals. Ninety-three per cent of public librarians had provided health information, with 79% using the Internet. The most popular sources of health information were magazines, books, local pharmacies and the Internet, but mostly for healthy lifestyle, not medical problems. CONCLUSIONS: E-health and medical informatics are high government priorities. Medical librarians are actively involved in these initiatives.

Databases as Topic↗

PubMed1993

B-chronic lymphocytic leukaemia in Latvia: epidemiological aspects.

As in western Europe and the USA, chronic lymphocytic leukaemia (CLL) in Latvia is the most prevalent type of leukaemia. A total of 1509 newly diagnosed cases of B-cell chronic lymphocytic leukaemia entered the study, 440 of whom were followed up at the Latvian Haematology Centre. The main peculiarities of the study were: 1) the higher incidence of the disease in Latvia as compared with other regions of the former USSR and with western countries, 2) a lower male-to-female ratio than in most other countries and 3) a higher morbidity among the Latvian population in comparison with the Russian. A positive correlation between the disease stage and survival was confirmed, but no precise individual prognosis in an early stage of the disease was possible.

Adult↗

PubMed1992

Nursing in Latvia from the perspective of Oppressed Theory.

Few nurses have the opportunity to witness the rebirth of a democratic state. The author, an American nurse of Latvian birth, served as a visiting professor at the Latvian Medical Academy, Department of Nursing, three weeks after Latvia had declared independence in August, 1991 during the coup d'etat of the Union of the Soviet Republics (USSR). In this article, the author shares and discusses her cultural experiences and reflections of Latvia from oppressed group theory perspectives. In an ever increasing pluralistic society, the author believes that nurses need the widening perspective of transcultural nursing to understand populations and changes in Eastern Europe. She further contends that nurses need a full understanding of what developed with the Latvians and what they have experienced during the last fifty years under communism.

Communism↗

PubMed2003

HLA class II associations with rheumatic heart disease among clinically homogeneous patients in children in Latvia.

Genetic control of immune reactions has a major role in the development of rheumatic heart disease (RHD) and differs between patients with rheumatic fever (RF). Some authors think the risk of acquiring RHD is associated with the HLA class II DR and DQ loci, but other views exist, due to the various HLA-typing methods and ways of grouping cases. Our goal was to determine the relations between HLA class II alleles and risk of or protection from RF in patients with relatively homogeneous clinical manifestations. A total of 70 RF patients under the age of 18 years were surveyed in Latvia. HLA genotyping of DRB1*01 to DRB1*18 and DQB1*0201-202, *0301-305, *0401-402, *0501-504, and *0601-608 was performed using polymerase chain reaction sequence-specific primers. Data for a control group of 100 healthy individuals typed for HLA by the same method were available from the databank of the Immunology Institute of Latvia. Of the RF patients, 47 had RHD and 8 had Sydenham's chorea. We concluded that HLA class II DRB1*07-DQB1*0401-2 and DRB1*07-DQB1*0302 could be the risk alleles and HLA class II DRB1*06 and DQB1*0602-8, the protective ones. Patients with mitral valve regurgitation more often had DRB1*07 and DQB1*0401-2, and patients with multivalvular lesions more often had DRB1*07 and DQB1*0302. In Sydenham's chorea patients, the DQB1*0401-2 allele was more frequent. Genotyping control showed a high risk of RF and RHD in patients with DRB1*01-DQB1*0301-DRB1*07-DQB1*0302 and DRB1*15-DQB1*0302-DRB1*07-DQB1*0303.

Adolescent↗