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The nursing education programme in Lithuania: voices of student nurses.

The nursing education programme in Lithuania has passed through many changes. The latest change has been carried out with support from Denmark. Ten female student nurses have been interviewed with the assistance of an interpreter. The purpose of this paper is to describe how student nurses perceived their preregistration training. The most outstanding feature of the nursing education programme in Lithuania was lack of adequate textbooks and students found this disadvantage caused a heavy workload. Students were spending the whole day in school, then studying during the evening. They were constantly tired. Although students were encouraged to be independent and to think actively during lectures, in reality this was difficult because of their workload. Students as a group were satisfied with their education, but they were doubtful about how to manage work as an independent nurse. Nowadays, many nurses in Lithuania view their work professionally and have taken over responsibility for some tasks that were carried out previously by physicians. Nurses trained previously may cause problems for newly graduated nurses because these nurses still work in a traditional manner. It will be impossible to evaluate the usefulness of the new nursing education programme in Lithuania until further investigations show how students qualify and manage their work as nurses.

Adolescent↗

Sociodemographic and health behaviour factors associated with obesity in adult populations in Estonia, Finland and Lithuania.

BACKGROUND: The aim of this study was to analyse the pattern of sociodemographic variations in the prevalence of obesity in Estonia, Finland and Lithuania. In addition, the association between obesity and selected health behaviours was examined. METHODS: Cross-sectional surveys were conducted among representative national samples of adult populations in 1994, 1996 and 1998. The number of participants aged 20-64 was 3759 in Estonia, 9488 in Finland and 5635 in Lithuania. The data were obtained from mailed questionnaires (covering sociodemographic characteristics, health behaviour indicators, and self-reported height and weight). Obesity was defined as BMI > or = 30 kg/m2. RESULTS: The prevalence of obesity among men and women was 10% and 15% in Estonia, 11% and 10% in Finland, and 10% and 18% in Lithuania respectively. The prevalence of obesity increased only among Estonian men. Obesity was more prevalent among those aged over 50 in all three countries. It was also more prevalent among the less educated women in all countries and among the less educated men in Finland. Obesity was less prevalent among daily smokers among Estonian men and women and Lithuanian men. Physically inactive Estonian women and Finnish men and women were more likely to be obese. CONCLUSIONS: A significant association was found between low educational level and obesity in women in all the countries, but this association was found for men only in Finland. In Finland obesity was also more consistently associated with indicators of unhealthy behaviour than in Estonia and Lithuania. Thus, even though the social gradient of obesity was broadly similar in all the countries studied, differences emerged with regard to the behavioural correlates of obesity.

Adult↗

Differences in mortality and coronary heart disease between Lithuania and The Netherlands: results from the WHO Kaunas-Rotterdam Intervention Study (KRIS).

BACKGROUND: A 9.5-year follow-up of the Kaunas-Rotterdam Intervention Study (KRIS) provided an opportunity to compare mortality patterns and rates in a population from Lithuania, one of the former republics of the Soviet Union, with a population from the Netherlands. These populations consisted of 2452 and 3365 males, respectively, aged 45-60 years. In 1972-1974, these males were extensively screened for cardiovascular risk factors, using uniform methods. METHODS AND RESULTS: During the follow-up, 303 males in Kaunas (Lithuania) and 350 males in Rotterdam (the Netherlands) died. Using Cox proportional hazards and logistic regression analysis, it was found that all-cause mortality rates during follow-up were 30% higher in Kaunas; this was mainly due to higher mortality rates from external causes (relative risk = 6.69), stomach cancer (RR = 2.78), stroke (RR = 2.30) and infectious diseases (RR = 12.43). The risk of fatal and non-fatal coronary heart disease (CHD) was, however, smaller in Kaunas (RR = 0.72). This lower risk closely corresponded with the Lithuanian risk profile which could be described by less smoking, lower cholesterol levels, and higher physical activity. As Lithuanians had a more advantageous cardiovascular risk profile, the higher Lithuanian all-cause mortality rates could not be explained by this risk profile. CONCLUSIONS: The results provide evidence for geographical differences in mortality and morbidity between Lithuania and the Netherlands. Population-specific health behaviours were shown to be involved in differences in the risk of CHD. The lower CHD rates in Eastern European communities in the 1970s, in this study confirmed for Lithuania, suggests that the apex of the CHD epidemic had not yet reached the Lithuanian population.

Blood Pressure↗

Daily variations in deaths in Lithuania: the possible contribution of binge drinking.

BACKGROUND: During the early 1990s the countries of the Former Soviet Union experienced a dramatic rise in mortality, especially from cardiovascular diseases. Although still poorly understood there is evidence, particularly from Russia, that this mortality crisis is partly linked to alcohol consumption. In this paper we use data from Lithuania to explore the daily variations of deaths and the probable relationship with binge drinking. METHODS: Computerized death certificates for those aged 20-59 years were analysed according to the day of death, place of death, and cause of death for the years 1988-1997. RESULTS: There is a marked increase in deaths from accidents, violence, and alcohol poisoning at the weekend, suggesting a pattern of binge drinking in Lithuania. There is also a significant increase in ischaemic heart disease (IHD) deaths on Saturdays, Sundays and Mondays. If the analysis is performed separately according to place of death, the day of the week effect is strengthened for cardiovascular deaths outside of hospital; consistent with the idea of a sudden cardiac death. CONCLUSION: The increase in mortality from cardiovascular diseases observed at the weekend in Lithuania is similar to that observed in Moscow and other populations. The relationship with alcohol consumption is supported by the available physiological evidence. We propose that bingeing can be solely responsible for, or acts as a 'catalyst' for, pathophysiological events by increasing blood pressure, cardiac rhythm and coagulability. The increased IHD mortality observed throughout the weekend and on Monday in Lithuania may reflect the influence of alcohol consumption patterns in a population already subject to high psychosocial stress.

Adult↗

Estimates of thyroid equivalent dose in Lithuania following the Chernobyl accident.

The volatile radioiodine was detected in Lithuania in the very first days after the Chernobyl accident. The proportion of gaseous 131I species of airborne iodine identified during that period exceeded from 2 to 4 times the aerosol fraction. The radioiodine activity of milk consumed by inhabitants of Lithuania varied over a broad range. 131I activity in milk reached a peak on the fourth day after deposition and then decreased with an effective half-time ranging from 4.2 +/- 0.6 d to 5.2 +/- 0.9 d. Thyroid examinations by dosimetric teams were not available in Lithuania for reasons beyond the control of experimenters. Because of this, thyroid equivalent doses were estimated using the modified ICRP three-compartment cyclic model. These calculations applied Monte Carlo methods and consideration of regional iodine deficiency to generate frequency distributions of equivalent doses to the infant and adult thyroid gland in three areas of Lithuania with different contamination levels.

Adult↗

Status of occupational cancer in Lithuania.

Because industrialization in Lithuania started only about 50 years ago, occupational cancer is only now becoming an important issue. This article describes the situation of occupational cancer in Lithuania: research, exposures to carcinogens, regulation, and legal practice. Epidemiologic studies of work-related cancers have shown increased risks among cement, textile, and asbestos-cement workers. In 1997, 28% of employed workers in Lithuania were exposed to carcinogens. A legislation system regulating exposures to carcinogens, harmonized with European Directives, has recently been created. In 1995-2003, there were 5,652 new cases of occupational diseases. However, occupational cancers are seriously underdiagnosed--only one case of cancer was diagnosed as occupational. Establishment of a system that would enable diagnosis, certification, and compensation of cases of occupational neoplasms is essential in Lithuania.

Carcinogens↗

Mortality in patients with childhood-onset type 1 diabetes in Finland, Estonia, and Lithuania: follow-up of nationwide cohorts.

OBJECTIVE: To assess mortality of population-based cohorts of childhood-onset type 1 diabetic patients from the Eastern European countries of Estonia and Lithuania and compare this information with recent data from Finland. RESEARCH DESIGN AND METHODS: Estonian (n = 518) and Finnish (n = 5,156) type 1 diabetic cohorts were diagnosed between 1980 and 1994, and the Lithuanian (n = 698) cohort was diagnosed between 1983 and 1994. The mortality of these cohorts was determined in 1995. Life-table analysis, Cox survival analysis with covariates, and standardized mortality ratios (SMRs) were used. Causes of death were analyzed. RESULTS: Survival after 10 years duration of type 1 diabetes was similar in Estonia (94.3%) and Lithuania (94.0%), but much higher in Finland (99.1%). In the Cox survival analysis with covariates, the country of origin and age at diagnosis were found to be significant predictors of mortality. The SMR for the Estonian cohort was 4.35 (95% CI 2.25-7.61), the highest for the Lithuanian cohort was 7.55 (4.89-11.15), and the lowest for the Finnish cohort was 1.62 (1.10-2.28). The most common cause of death in Estonia and Lithuania was diabetic ketoacidosis (DKA), and in Finland, it was violent causes. No deaths from late complications of diabetes have been documented so far in any of the three countries. CONCLUSIONS: Our results demonstrate a high rate of short-term deaths due to DKA and inferior survival of childhood-onset type 1 diabetic patients in Estonia and Lithuania compared with Finland. In Finland, the survival of childhood-onset type 1 diabetic patients has improved and is only slightly inferior to that of the background population.

Adolescent↗

Membranoproliferative glomerulonephritis is still the most frequent glomerulonephritis in Lithuania.

BACKGROUND: In Lithuania renal biopsies (RB) have become routine since 1995. Our study attempted to analyze RB for 5 years in Lithuania. METHODS: We analyzed data of adult patients who underwent native kidney biopsies in 6 renal units in the period between 1995 - 1999. It accounted for 62.5% of all kidney biopsies, done throughout Lithuania. All biopsy specimens were examined by the same pathologist using light- and immunofluorescence microscopy. RESULTS: A total of 316 renal biopsies was analyzed; males : females 1.8 : 1. The mean age was 41.4 +/- 16.7 years. The most common indications for biopsy was nephrotic syndrome (29.1%) and urinary abnormalities (27.8%). After exclusion of inadequate biopsies in the remaining 280 RB, primary glomerulonephritis (GN) accounted for 68.7% and secondary GN for 19.5%. The most frequent forms of primary GN were membranoproliferative GN and immunoglobulin A nephropathy (17.9% and 15.4%, respectively), followed by membranous nephropathy (7.1%) and focal segmental glomerulosclerosis (6.8%). CONCLUSIONS: The main indication for renal biopsy in Lithuania was nephrotic syndrome, which was followed by isolated urinary abnormalities. The leading type of kidney damage was primary glomerulonephritis, which was 2.4 times more frequent in males than in females. The most frequent form of primary glomerulonephritis was membranoproliferative GN, with dominance in males. Immunoglobulin A nephropathy was the second form of primary GN according to the frequency.

Adult↗

Laypersons' expectation of the sequelae of whiplash injury. A cross-cultural comparative study between Canada and Lithuania.

BACKGROUND: The objective of the present study is to compare the frequency and nature of expected 'whiplash' symptoms in Lithuania (a country where the late whiplash syndrome is rare or unknown) with that in Canada. MATERIAL/METHODS: A symptom checklist was administered to 2 subject groups selected from local companies in Kaunas, Lithuania, and Edmonton, Canada, respectively. Subjects were asked to imagine having suffered a neck sprain (whiplash injury) with no loss of consciousness in a motor vehicle accident, and to check which, of a variety of symptoms, they would expect might arise from the injury. For symptoms they anticipated, they were asked to select the period of time they expected those symptoms to persist. RESULTS: In both the Lithuanian and Edmontonian groups, the pattern of symptoms anticipated closely resembled the acute symptoms commonly reported by accident victims with acute neck sprain, but while up to 50% of Edmontonians also anticipated symptoms to last months or years, very few Lithuanian subjects selected any symptoms as likely to persist. CONCLUSIONS: In Lithuania, despite the documented occurrence of neck sprain symptoms in some 50% of individuals following motor vehicle accidents, there is a very low rate of expectation of any sequelae from this injury. What current or previous aspects of society that underlie this remain uncertain. This lack of expectation of chronicity in Lithuania may, in part, determine the low prevalence of the late whiplash syndrome there. Further studies of symptom expectation as an etiologic factor in the late whiplash syndrome are needed.

Accidents, Traffic↗

[Development of hemodialysis service in Lithuania during (1996-2003)].

The aim of our study was to evaluate the changes of hemodialysis (HD) service and main demographic characteristics of HD patients in Lithuania during seven years period. From 1996 to 2003 we visited annually all HD centers in Lithuania and collected data about all HD patients. There was a sharp increase in the number of HD centers (from 17 to 37), HD stations (from 25 p. m. p. (per million population) to 87 p.m.p.; p<0.001), HD patients (from 60 p.m.p. to 264 p.m.p.; p<0.001) and incidence of new HD patients (from 54.3 p.m.p. to 92 p.m.p.; p<0.01). In 1996 all 17 HD centers in Lithuania were public. Private HD centers appeared in 1998 and reached 43.2% of all HD centers (n=16) in 2003. 44.8% of HD patients were dialyzed in private HD centers. The mean age of HD patients increased from 47.2+/-16.1 years in 1996 to 57.5+/-14.9 years in 2003 (p<0.001). HD population became older. The percentage of patients over 60 years old increased from 22.8% to 49.7% (p<0.001) and over 70 years old--from 54% to 21.9% (p<0.001). The main underlying disease of end-stage renal disease was chronic glomerulonephritis but its rate had decreased from 54.5% in 1996 to 26.5% in 2003 (p<0.001). During this period there was a statistically significant increase in the incidence of end-stage renal disease due to diabetics (from 7.1% to 18.0%; p<0.01), hypertensive nephropathy (from 3.1% to 9.4%; p<0.05), and chronic pyelonephritis (from 11.2% to 18.6%; p<0.01). In summary during the last seven years HD service in Lithuania expanded significantly, and rapid development of private HD was observed. The number of HD patients was rising continuously with predominance of diabetic, hypertensive and elderly patients.

Adolescent↗

Molecular epidemiology of tick-borne encephalitis virus in Ixodes ricinus ticks in Lithuania.

In Lithuania, 171-645 serologically confirmed cases of tick-borne encephalitis occurred annually [Mickiene et al. (2001): Eur J Clin Microbiol Infect Dis 20:886-888] in 1993-1999, and the tick-borne encephalitis virus (TBEV) seroprevalence in the general population was found previously to be 3.0% [Juceviciene et al. (2002): J Clin Virol 25:23-27]. To assess the risk for TBEV virus infection in Lithuania and to characterize the agent a panel of 3,234 ticks combined into 436 pools [Juceviciene et al., 2005] were tested for presence of TBEV RNA by a nested RT-PCR targeting at the NS5 gene. Six pools were confirmed positive and the prevalence of the infected ticks was 0.2% (if one tick per pool [Juceviciene et al., 2005] was considered positive) and the proportion of positive tick pools was 1.4%. The prevalence of the infected ticks in the Panevezys, Siauliai, and Radviliskis regions (in central Lithuania) was 0.1%, 0.4%, and 1.7% corresponding with a higher TBE disease burden in these regions. The 252-nucleotide NS5-region amplicons, and a longer sequence (737 nucleotides) obtained from one sample from the PrM-E gene region, were sequenced. Phylogenetic analysis of the latter showed that all western type TBEV PrM-E sequences, including the Lithuanian strains, were monophyletic, showed no clustering and had very little variation. The NS5 sequences, although identical within one locality, did not show any mutations common to strains from the two Lithuanian regions, nor could any geographical clustering be found among western type TBEV strains from other areas.

Animals↗

Molecular epidemiology of Trichinella spp. in three Baltic countries: Lithuania, Latvia, and Estonia.

Meat of domestic pigs and wild boars has been the significant source of emerged human trichinellosis in Lithuania, Latvia, and Estonia over the past two decades. However, there is very little known on the occurrence of Trichinella spp. in main wildlife reservoirs and its transmission in domestic and sylvatic cycles in these countries. The present study demonstrated considerably higher endemicity of Trichinella spp. in main sylvatic reservoirs (28.9-42% in foxes (Vulpes vulpes) and raccoon dogs (Nyctereutes procyonoides) in all three countries than previously reported. Molecular identification of Trichinella larvae from more than 500 sylvatic and domestic animals revealed four Trichinella species (Trichinella spiralis, Trichinella britovi, Trichinella nativa, and Trichinella pseudospiralis) sympatric in a relatively small area and several as the first records for the respective countries. The nonencapsulating T. pseudospiralis is found for the first time in the Eastern Europe. Sylvatic T. britovi was found in domestic pigs in Lithuania and Latvia (16 and 57.1%, respectively) and only in these countries, domestic T. spiralis was detected in sylvatic animals in areas where domestic trichinellosis was registered. The study suggests that transmission of Trichinella between domestic and sylvatic cycles in Lithuania and Latvia is favored by improper human behavior, e.g., pig and slaughter waste management.

Animals↗

Management of patients with ruptured cerebral aneurysms in hospital population of Lithuania.

A retrospective analysis of ruptured cerebral aneurysms among the hospital population of Lithuania was performed. A total of 507 patients were enrolled in the study during a 5 year period. The unadjusted annual incidence of ruptured cerebral aneurysms was found to be 2.7/100,000 in the hospital population of Lithuania and 3.9/100,000 in the hospital population of the defined area of the city of Kaunas. Overall management results showed a 45. 6% good recovery and 31.6% death rate in this group of patients. Surgical results showed a 52.1% good outcome and 20.9% death rate. Despite the fact that the death rate according to the timing of surgery after the initial subarachnoid haemorrhage did not differ significantly (p >0.05) among early (0-3 days post SAH), moderate (4-7 days post SAH) and late (more than 7 days post SAH) surgery groups, it was found that 75 (14.8%) patients deteriorated while awaiting surgery. Initial bleeding together with rebleeding, medical complications and vasospasm were the main causes of death, constituting 61.3%, 18.1% and 9.4% of all deaths, respectively. The results of this study showed that the annual incidence of ruptured cerebral aneurysms in Lithuania is similar to that in other European countries except for Finland. Overall management results in the Lithuanian hospital population indicated only a slight improvement compared to management results of previous population-based studies in other countries.

Aneurysm, Ruptured↗

[Surveillance of animal and human rabies in Lithuania from 1991 to 2001].

OBJECTIVE: The objective of this study was to assess the epidemiology of rabies in Lithuania from 1991 to 2000. MATERIALS AND METHODS: Data available from the reports of the Lithuanian State Food and Veterinary Service, of the Public Health centers, of the Veterinary Laboratories of counties, districts and cities, and from the reports of the Lithuanian Ministry of Agriculture and the Environment Protection Department were used to assess rabies both in domestic animals and wildlife. The situation of human rabies from 1991 to 2000 was evaluated using the medical records of patients with a diagnosis of rabies and the epidemiological follow-up of people receiving post-exposure treatment. RESULTS: From 1991 to 2000, 2,148 laboratories confirmed cases of rabies were diagnosed in animals in Lithuania. Domestic animals accounted for 44% of all cases whereas wild animals accounted for 56% of the cases. During the 10-year period of investigation, 5 human cases were reported and 44,710 bitten persons received post-exposure treatment. COMMENTS: A high incidence of rabies in wild animals in Lithuania had a direct influence on the increase human rabies infection. It is necessary to improve preventive measures against rabies - vaccination of domestic and wild animals, and spread information on rabies to the general public.

Animals↗

Wet deposition of elemental carbon in Lithuania.

Elemental carbon (EC) was measured in monthly precipitation samples at 14 rural sites in Lithuania from December 1986 to June 1990. The amount of EC in the sample was determined by the light reflectance method after a procedure including the filtration through a 0.2-micron polyamide membrane filter, the chemical digestion of biogenic material and the dispersion of the mixture in an ultrasonic bath. Monthly elemental carbon concentrations in the precipitation samples during the measurement period at the Preila site varied from 8 to 530 micrograms l-1 with a volume-weighted mean of 100 micrograms l-1. The range of EC monthly deposition fluxes was from 0.5 to 25 mg m-2 month-1 for all the sites. The wet deposition of elemental carbon is doubled during the cold season of the year. The estimated mean value of EC washout ratio for Preila site is 97 (range 5-243). An even distribution of the elemental carbon deposition is characteristic for the rural sites in Lithuania and mean monthly deposition flux can be estimated as 6.2 mg m-2 month-1. It results in the deposition of approximately 4800 t of elemental carbon to the area of Lithuania annually.

Air Pollutants↗

Symptom expectation after minor head injury. A comparative study between Canada and Lithuania.

OBJECTIVES: The purpose of the present study is to compare the frequency and nature of expected symptoms in Lithuania (a country where the chronic post-concussive syndrome is largely unknown) with that in Canada. METHODS: A symptom checklist was administered to two subject groups selected from local companies in Kaunas, Lithuania, and Edmonton, Canada, respectively. Subjects were asked to imagine having suffered head trauma with loss of consciousness in a motor vehicle accident, and to check off symptoms they expected might arise from the injury. For symptoms they anticipated, they were asked to select the period of time they expected those symptoms to persist. RESULTS: In both the Lithuanian and Edmontonian groups, the pattern of symptoms anticipated closely resembled the acute symptoms commonly reported by accident victims with minor head injury. Yet, while many Edmontonians also anticipated symptoms to last months or years, very few Lithuanian subjects selected any symptoms as being likely to persist in a chronic manner. CONCLUSIONS: In Lithuania, despite the frequent experience of minor head injury in motor vehicle accidents, there is a very low rate of expectation of any chronic sequelae from such an injury, contrasting greatly with the response shown in Canada, where the prevalence of the chronic post-concussive syndrome is higher. Symptom expectation in some countries may be an important factor in the development of the chronic post-concussive syndrome.

Brain Injury, Chronic↗

Determinants of daily smoking in Estonia, Latvia, Lithuania, and Finland in 1994-2002.

AIMS: To investigate time trends in the smoking prevalence and the sociodemographic and psychosocial background of smoking in the Baltic countries in comparison with Finland during 1994-2002. METHODS: Differences in daily smoking according to age, education, urbanization, and psychological distress in the Baltic countries and Finland were studied using postal surveys in 1994, 1996, 1998, 2000, and 2002 among adults (20-64 years old) in Estonia (n = 6,271), Latvia (n = 6,106), Lithuania (n = 9,824), and Finland (n = 15,764). RESULTS: In 1994, 1996, 1998, 2000, and 2002 the prevalence of smoking in Estonia, Latvia, Lithuania, and Finland was 47%, 54%, 46%, and 29% among men, and 21%, 19%, 11%, and 19% among women, respectively. Smoking increased among Lithuanian women from 6% in 1994 to 13% in 2002, but decreased among Estonian men and women. Smoking was generally more common among younger individuals, the less educated, and people with distress in all four countries. The odds ratios for smoking for those with low education compared with those with high education were 2.18 (1.69-2.81), 3.32 (2.55-4.31), 2.20 (1.79-2.70) and 2.80 (2.40-3.27) in men, and 1.90 (1.42-2.52). 3.09 (2.28-4.18), 0.86 (0.59-1.26), and 3.00 (2.53-3.55) in women, in Estonia, Latvia, Lithuania, and Finland, respectively. There were indications of increasing educational differences in Latvian men. Smoking was less common among rural women in all countries except Estonia. CONCLUSIONS: Estonia, Latvia, and Finland show characteristics of the "mature" phase of a smoking epidemic, and smoking may not increase in these countries. In Lithuanian women smoking may increase. Smoking may be increasingly unequally distributed in the future in all the studied countries.

Adult↗

Smoking and passive smoking in Estonia, Lithuania and Finland. Identifying target groups of tobacco policy.

BACKGROUND: The aim of this study was to identify population groups which are the most crucial as targets for anti-tobacco action. METHODS: A comparison was made of the prevalence and patterns of smoking and passive smoking in Estonia, Finland and Lithuania. RESULTS: Total exposure to smoking, both one's own and passive smoking, was more common in two Baltic countries than in Finland. In these Baltic countries passive smoking was notably common among women. In all countries the exposure was more prevalent among the younger and less educated, but no difference emerged between urban and rural areas. CONCLUSIONS: The following target groups were identified as priorities for anti-tobacco actions: i) men of all ages in Estonia and Lithuania to stop their already established tobacco use, ii) young women in all three countries to prevent their starting a career of tobacco use and iii) young and less educated women in Estonia and Lithuania to prevent passive smoking, i.e. their exposure to environmental tobacco smoke.

Adult↗