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PubMed1995

Avoidable mortality in Lithuania.

STUDY OBJECTIVE: The study aimed to analyse avoidable mortality in Lithuania as an index of the quality of health care and to assess trends in avoidable mortality from 1970-90. SETTING AND PARTICIPANTS: All deaths of Lithuanian residents aged between 0 and 64 years between 1970 and 1990 were analysed. MEASUREMENTS AND MAIN RESULTS: Twenty seven per cent of all deaths in this age group were avoidable. Avoidable deaths were grouped into preventable and treatable ones. Treatable causes of death accounted for 54%, and preventable, 46% of avoidable mortality. Time trends showed that general mortality and mortality from avoidable causes of death in this age group were almost stable between 1970 and 1990. Mortality from treatable causes of death fell, while deaths from preventable causes increased. The results in the preventable group were greatly affected by deaths from malignant neoplasms of trachea, bronchus, and lungs. Differences were noted between the sexes in total mortality as well as in avoidable mortality. CONCLUSIONS: Avoidable causes of death are relatively common and, consequently, they are of practical importance for public health and studies of the health care quality in Lithuania. Reorganisation of health care is to be carried out and considerable emphasis will be placed on health education, promotion, and prevention, as primary prevention measures have not been effective thus far.

Adolescent↗

PubMed2004

Low job control and myocardial infarction risk in the occupational categories of Kaunas men, Lithuania.

STUDY OBJECTIVE: To determine the association between adverse psychosocial characteristics at work and risk of first myocardial infarction in the occupational categories of Kaunas men, Lithuania. DESIGN: The analysis was based upon a case-control study among full time working men in the general population of Kaunas. OUTCOME MEASURE: First non-fatal myocardial infarction diagnosed in 2001-2002. The Swedish version of the demand-control questionnaire was used to examine the effect of job control and demands. SETTING: Kaunas, the second largest city in Lithuania, a former socialist country in a transition market economy. PARTICIPANTS: Cases were 203 men 25-64 years of age with a first non-fatal myocardial infarction and controls were 287 men group randomly selected from the study base. MAIN RESULTS: Low job control had a significant effect on myocardial infarction risk in the general 25-64 year old Kaunas male population (OR = 2.68; 95% CI 1.68 to 4.28) after adjustment for age and socioeconomic status. Low job control was a risk factor in the occupational categories of the increased myocardial infarction risk (1st occupational category--legislators, senior officials and managers and the 8th--plant and machine operators and assemblers; OR = 2.78; 95% CI 1.31 to 5.93 and 2.72; 95% CI 1.56 to 4.89, respectively, after adjustment for age and socioeconomic status). Though the adjusted odds ratio estimates were significantly high for the rest of the occupational categories (2nd--professionals, 3rd--technicians and associate professionals, and 7th--craft and related trades workers). CONCLUSIONS: The association between low job control and first myocardial infarction risk was significant for all occupational categories of Kaunas men.

Epidemiologic Factors↗

PubMed1999

Work related risk factors for musculoskeletal complaints in the spinning industry in Lithuania.

OBJECTIVES: To describe the prevalence of self reported musculoskeletal complaints in the back, arms or neck, and legs among workers in the spinning industry, and to investigate the relations between these complaints and work related variables. METHODS: An interview based questionnaire survey was carried out in two spinning industry factories in Lithuania. RESULTS: The study group consisted of all workers in production (n = 363). Symptoms of the legs were the musculoskeletal symptom reported most often (61%). Many subjects had arms or neck (55%) or back problems (28%). 20% had experienced pain from all three sites. Almost 25% had had musculoskeletal pain every day and 16% had experienced constant pain during previous year. Packers had the highest risk of arms or neck problems whereas spinners had the highest risk of back or leg problems. Working in a strained posture (bending, work with arms raised up above shoulder level, and repetitive movements of the fingers) was associated with all three complaints. Only arms or neck complaints were associated with age. CONCLUSIONS: Musculoskeletal disorders are a common problem among workers producing gobelin or synthetic thread in Lithuania and working in a strained posture is a risk factor for developing musculoskeletal disorders in three body sites: legs, arms or neck, and back. To better understand the different aspects of physical load as risk factors, a more detailed study of the frequency of postural changes as well as an observation of individually adopted postures would be necessary. This applies to intervention studies in factories of the spinning industry to prevent complaints of the legs and shoulders.

Adolescent↗

PubMed2006

Challenges and opportunities of health care for the aging community in Lithuania.

The aim of this paper is to present the Lithuanian experience in creating a geriatric care system with the hope that it can be of some use to other countries undergoing similar transitions and changes. The Lithuanian population is old with 20% of the population being 60 years and older, and 15% being 65 years and older, with the trend toward a rapidly aging society. In 1990, Soviet rule in Lithuania ceased and the country regained its independence. With its recent acceptance into the European Union, the nation has set goals to meet the recommended requirements for the care of the elderly. The changes began with specialist training in gerontology and geriatrics, and were an essential first step to bridge the gap between the real and the future needs. Later, the Geriatric Care System Development Program was approved by the Ministry of Health. Despite its difficult past, Lithuania is confronting the challenges of health and social care of the aging population. It is embracing the opportunities to initiate policies and related measures to meet these challenges, and is potentially setting an example of good practice as a new European community.

Aged↗

PubMed1995

Epidemiology of stroke in Kaunas, Lithuania. First results from the Kaunas Stroke Register.

BACKGROUND AND PURPOSE: In Lithuania, only routine mortality statistics have thus far provided data on the epidemiology of stroke. This study aims to assess the mortality, incidence, and case-fatality rate of stroke in the city of Kaunas, Lithuania, during 1986 to 1988. METHODS: A community-based stroke register was set up in 1986 to collect data on all suspected events of acute stroke that occurred in the population aged 35 to 64 years permanently residing in Kaunas. Crude and age-standardized attack rates, incidence, mortality, and case-fatality rates were calculated for the period studied. RESULTS: Among men, the average age-standardized incidence of stroke (referring to first-ever events) was 230/100,000, the attack rate (all events) was 300/100,000, and the mortality from all strokes was 68/100,000. Among women, the corresponding rates were 131/100,000, 154/100,000, and 35/100,000, respectively. Of 973 acute stroke events registered, 80% were first-ever strokes. The age-adjusted 28-day overall case-fatality rate and the case-fatality rate of first-ever stroke were 23.3% and 19.8% in men and 21.8% and 21.3% in women, respectively. CONCLUSIONS: The findings from this first assessment of the incidence and mortality of stroke show that in the mid-1980s both were high in Kaunas compared with other countries. The case-fatality rate was similar to that reported for most other European countries. Further investigations are being carried out to assess the trends in mortality, incidence, and risk factors of stroke in the Kaunas population.

Adult↗

PubMed2005

Hospitalization in hemodialysis patients in one region of Lithuania.

INTRODUCTION AND METHODS: The objective of our study was to evaluate hospitalization rates in hemodialysis patients in the region of Kaunas, the second largest city in Lithuania. We analysed ambulatory case records of 187 ESRD patients dialysed in all 7 hemodialysis centers in the Kaunas region over the year 2002. RESULTS: During the year 2002 the unadjusted hospitalization rate over a 1 year period in all dialysed patients (the prevalent patients, n=187) was 1.4 hospitalizations per patient year at risk. There were 17.5 hospital days per patient year at risk, the mean length of one hospitalization being 12.5 days. The most frequent causes of hospitalization were cardiovascular diseases (25%), infections (22%), and access related complications (10%). Of the 187 patients, 55 started hemodialysis in the year 2002 (incident patients). The comparison of prevalent patients with incident patients revealed a higher hospitalization rate in the incident patients (unadjusted hospitalization rate was 1.9 hospitalizations per patient year at risk). The length of hospitalization (29.1 hospital days per patient year at risk) and the mean length of one hospitalization (15.1 days) were longer in the incident patients than the prevalent patients. In the year 2002, the National Sickness Fund paid $361 per year for hospitalizations of one hemodialysis patient and $10,800 per year for the dialysis procedures of one hemodialysis patient. CONCLUSIONS: The hospitalization rate in Lithuania for patients undergoing hemodialysis is similar to that of other European countries while hospitalization costs are lower.

Comorbidity↗

PubMed2005

Health care reform and job satisfaction of primary health care physicians in Lithuania.

BACKGROUND: The aim of this research paper is to study job satisfaction of physicians and general practitioners at primary health care institutions during the health care reform in Lithuania. METHODS: Self-administrated anonymous questionnaires were distributed to all physicians and general practitioners (N = 243, response rate - 78.6%), working at Kaunas primary health care level establishments, in October - December 2003. RESULTS: 15 men (7.9%) and 176 women (92.1%) participated in the research, among which 133 (69.6%) were GPs and 58 (30.4%) physicians. Respondents claimed to have chosen to become doctors, as other professions were of no interest to them. Total job satisfaction of the respondents was 4.74 point (on a 7 point scale). Besides 75.5% of the respondents said they would not recommend their children to choose a PHC level doctor's profession. The survey also showed that the respondents were most satisfied with the level of autonomy they get at work - 5.28, relationship with colleagues - 5.06, and management quality - 5.04, while compensation (2.09), social status (3.36), and workload (3.93) turned to be causing the highest dissatisfaction among the respondents. The strongest correlation (Spearmen's ratio) was observed between total job satisfaction and such factors as the level of autonomy - 0.566, workload - 0.452, and GP's social status - 0.458. CONCLUSION: Total job satisfaction of doctors working at primary health care establishments in Lithuania is relatively low, and compensation, social status, and workload are among the key factors that condition PHC doctors' dissatisfaction with their job.

Adult↗

PubMed2006

Increasing thyroid cancer incidence in Lithuania in 1978-2003.

BACKGROUND: The aim of this paper is to analyze changes in thyroid cancer incidence trends in Lithuania during the period 1978-2003 using joinpoint regression models, with special attention to the period 1993-2003. METHODS: The study was based on all cases of thyroid cancer reported to the Lithuanian Cancer Registry between 1978 and 2003. Age group-specific rates and standardized rates were calculated for each gender, using the direct method (world standard population). The joinpoint regression model was used to provide estimated annual percentage change and to detect points in time where significant changes in the trends occur. RESULTS: During the study period the age-standardized incidence rates increased in males from 0.7 to 2.5 cases per 100,000 and in females from 1.5 to 11.4 per 100,000. Annual percentage changes during this period in the age-standardized rates were 4.6% and 7.1% for males and females, respectively. Joinpoint analysis showed two time periods with joinpoint in the year 2000. A change in the trend occurred in which a significant increase changed to a dramatic increase in thyroid cancer incidence rates. Papillary carcinoma and stage I thyroid cancer increases over this period were mainly responsible for the pattern of changes in trend in recent years. CONCLUSION: A moderate increase in thyroid cancer incidence has been observed in Lithuania between the years 1978 and 2000. An accelerated increase in thyroid cancer incidence rates took place in the period 2000-2003. It seems that the increase in thyroid cancer incidence can be attributed mainly to the changes in the management of non palpable thyroid nodules with growing applications of ultrasound-guided fine needle aspiration biopsy in clinical practice.

Adolescent↗

PubMed2006

Blood donors' motivation and attitude to non-remunerated blood donation in Lithuania.

BACKGROUND: In the Soviet period, the blood donation system operated in Lithuania exclusively on a remunerative basis. After joining the EU, Lithuania committed itself to meeting the EU requirements to provide all consumers within its boundaries with safe blood products made from voluntary unpaid blood donations. However, the introduction of a non-remunerated donation system may considerably affect donors' motivation and retention. Thus the aim of the current research was to determine blood donation motives among the present donors and investigate their attitude towards non-remunerated donation. METHODS: A questionnaire survey of 400 blood donors. Survey data processed using SPSS statistical analysis package. Statistical data reliability checked using Fisher's exact test (p < 0.05). RESULTS: Paid donors comprised 89.9%, while non-paid ones made 10.1% of the respondents. Research findings show that 93 per cent of the paid donors give blood on a regular basis; while among the non-remunerated donors the same figure amounted merely to 20.6 per cent. The idea of the remuneration necessity is supported by 78.3 per cent of the paid donors, while 64.7 per cent of the non-remunerated respondents believe that remuneration is not necessary. The absolute majority of the paid donors (92%) think they should be offered a monetary compensation for blood donation, while more than half of the non-remunerated donors (55.9) claim they would be content with a mere appreciation of the act. Provided no remuneration were offered, 28.44 per cent of the respondents would carry on doing it, 29.6 per cent would do it only in emergency, 29.6 per cent would donate blood merely for their family or friends, and 12.3 per cent would quit it completely. CONCLUSION: Most respondents admitted having donated blood for the following reasons: willingness to help the ill or monetary compensation. Majority would consent to free blood donation only in case of emergency or as a family replacement, which leads to a conclusion that provided monetary remuneration is completely terminated part of the currently active paid donors would withdraw from this activity, which might seriously affect the national supply of blood and its products.

Adult↗

PubMed2006

The prevalence of systemic lupus erythematosus in Lithuania: the lowest rate in Northern Europe.

The aim of this study was to explore the prevalence of systemic lupus erythematosus (SLE) in Lithuania (Vilnius). Two different studies were designed for SLE cases identification: registry-based SLE study and population-based SLE study. For the registry-based study patients were enrolled during the period of 1999-2004 and from two sources, including out-patient clinics of Vilnius and tertiary rheumatology center with interview during the year 2004. Only Vilnius residents who fulfilled the ACR 1982 revised criteria for the classification of SLE were counted in this study. Seventy-six living adult patients with SLE were interviewed and accounted for the prevalence of 16.2/100000 (0.016%) using the Vilnius adult population in January 2004 (a population of 470451). The population study of randomly selected 10,000 Vilnius inhabitants with beforehand validation of the survey was performed in the same year. The population-based study revealed two cases for 4017 respondents, but the low response rate may be important. Extrapolating the results to population of 10000 inhabitants, the point prevalence of SLE in the entire sample was at least 0.02%. Therefore, the prevalence of SLE in Lithuania is the lowest if compared to Northern European countries.

Adolescent↗

PubMed1999

Sexually transmitted diseases in Lithuania: some epidemiological and social aspects.

With political, economical and social changes in Lithuania following the break-up of the Soviet Union, the health-care system has changed. The old Soviet system has been abandoned and it has taken time to re-establish a system under the new government. Resources are limited in most aspects of health care, including sexually transmitted infections (STIs). This has, also limited the development of education packages on STIs which are so important when trying to combat the spread of HIV infection. Notifications of syphilis, in Lithuania, have increased 52 fold between 1990 and 1996 although, since then, the incidence has started to decrease. Syphilis has been more reliably notified than other STIs and serves as the most reliable indicator of STI trends.

Adolescent↗

PubMed2003

Age-related trends in mortality from COPD in Lithuania, 1989 to 1998.

OBJECTIVE: To assess the age-related trends in mortality from COPD in middle-aged and elderly populations of Lithuania during a 10-year period (1989 to 1998). METHODS: Annual mortality was reported as the age-standardized mortality rates. Mortality rates were standardized to the 1989 European population. Trends in mortality were assessed by logarithmic regression coefficient beta that, expressed by percentage, estimated the average annual change in mortality. RESULTS: Analysis of mortality from COPD in the Lithuanian population during this 10 years revealed that mortality rates directly related to older age, and the indexes of men in various age groups were twofold to threefold greater than those of women. Annual change in mortality assessed by logarithmic regression coefficient in men aged 35 to 64 years was - 5.7% (p = 0.002) and in age group >or= 65 years it was - 2.9% (p = 0.001); in women, the change in mortality was - 7.2% (p = 0.006) and - 2.5% (p = 0.03), respectively. CONCLUSION: Mortality from COPD in Lithuania during the 10-year period was decreasing in middle-aged and elderly populations and in both men and women. Decrease in mortality occurred at a slower rate in the elderly population than in middle-aged population.

Adult↗

PubMed1998

Epidemiological surveillance of rabies in Lithuania from 1986 to 1996.

Rabies has been endemic in Lithuania for centuries. The objective of this study was to evaluate rabies incidence and seasonal trends in domestic and wild animals in Lithuania from 1986 to 1996. Annual rabies reports and data on cattle numbers were collected. Descriptive epidemiology and time series data analyses were performed to detect seasonal trends. A total of 1,475 specimens were submitted for rabies testing. Of these, 1,248 (84.6%) were confirmed as rabies cases by immunofluorescence antibody testing. Domestic animals accounted for 73.8% (921/1,248) of all rabies cases, with cattle accounting for 61.1% (563/921) of domestic animal cases. Wildlife cases were reported principally in red foxes (56%; 183/327) and raccoon dogs (31.2%; 102/327). Time series analysis indicated a strong association between the occurrence of rabies in cattle and the season of the year (P = 0.0032), with the highest incidence of rabies occurring in autumn. The incidence declined from 3.4 to 4.8 cases per 100,000 cattle in the mid-1980s to < 1.5 cases per 100,000 cattle in 1994, but increased to 4.2 cases per 100,000 cattle in 1996. However, as the cattle population dramatically decreased (by 54%) over the eleven-year period of the study, the reduction in the total number of rabies cases in cattle was not reflected in the annual incidence rate of cattle rabies.

Animals↗

PubMed1995

Radiology in Lithuania: impressions of a visiting professor.

In the fall of 1993, I had the privilege of spending 3 months as a Radiological Society of North America (RSNA) International Visiting Professor at the Kaunas Medical Academy in Lithuania. This visiting professor program was started in 1986 and is funded by the RSNA Research and Education Fund [1]. It is designed for a visiting professor who can spend 3 months or longer at a radiology residency training program in an evolving country. Lithuania, with a population of about 4 million, is located on the eastern shore of the Baltic Sea, just north of Poland. The land area is approximately equal to that of Switzerland. An independent country until World War II, when it was forcibly occupied and integrated into the Soviet Union, it regained independence in 1990. As a result of 50 years of communist rule, two generations grew up having little knowledge about Western medicine in general and radiology in particular. A communist legacy is still evident not only in education but also in the thought process of the people, although there is a clear desire to integrate into western Europe. Currently Western and Asian consumer goods are readily available, but the country has undergone steep inflation and it is the perception of many that the standard of living continues to decline.

Internship and Residency↗

PubMed1994

Immunity from diphtheria, tetanus, poliomyelitis, measles, mumps and rubella among adults in Lithuania.

Health authorities have estimated a low immunity level against diphtheria, tetanus, poliomyelitis, measles, mumps and rubella among adults in Lithuania due to less than optimal vaccine quality. The aim of this study was to evaluate the level of immunity by blood sampling 100 young women, 50 young men and 50 middle-aged men and from the immunization history by questionnaire. Lack of protection against diphtheria was found in 0%, 2% and 46% of the young women, young men and middle-aged men respectively. The corresponding data for tetanus were 0%, 0% and 10%. It was found that 85% of the women had antibodies to all 3 types of polioviruses vs. 80% of the young men and 56% of the middle-aged men. A sub-protective antibody level against measles was found in 12% of the women, 22% of the young men, but in none of the middle-aged men. A protective titre of rubella antibodies was found among 94% of the young, pregnant women. It can be concluded that the level of immunity in Lithuania is comparable to that in Western Europe for the same age groups and that the launching of adult vaccination programs in Eastern Europe should be preceded by sero-epidemiological studies.

Adult↗

PubMed1994

Lyme borreliosis in Lithuania.

The first cases of Lyme borreliosis in Lithuania were diagnosed in 1987, since when the number of reported cases has varied between 50 and 300 per year. In 1988, 354 cases were found through active surveillance. During 1988-91, 3,820 Ixodes ricinus ticks were collected in Lithuania; 11% of adult and 1% of nymphal ticks were infected with borrelia as determined by dark-field microscopy. Infected ticks were found in 27/31 (87%) of the regions investigated. Two isolates of Borrelia were obtained by in vitro cultivation and were shown to be Borrelia burgdorferi according to their reactions with species-specific monoclonal antibodies. From a survey of 6,187 people we estimated that 2,811/100,000 of the Lithuanian population are bitten by ticks every year. The prevalence of antibodies to B. burgdorferi measured by indirect IFA in healthy people varied between 4% and 32%, depending upon occupation and exposure to ticks.

Animals↗

PubMed1996

Rate of characteristics for osteoporotic fractures in the elderly population of Kaunas region, Lithuania.

Osteoporosis related with age is a well known problem in many Western countries. First investigations on osteoporosis in Lithuania were started few years ago. We investigated the rate of characteristic for osteoporosis fractures according to Kaunas Red Cross Hospital regional Traumatology department data. We have studied all cases of inpatients and outpatients over 65, who had Colles', hip or vertebral fracture, as this department serves for all Kaunas region, (580000 inhabitants: 17000 male and 35500 female over 65). The rate of fractures was counted per 1000 inhabitants over 65, comparing 1991 and 1993. We found, that about 1.65/1000 of men and 7.52/1000 of women had Colles' fracture in 1991, when the rate in 1993 accordingly was 1.60/1000 and 10.56/1000. The greater increase in rate we noticed studying cases of hip fractures: 1.60/1000 of men and 3.09/1000 of women in 1991, when 4.70/1000 of men and 6.76/1000 of women in 1993. We did not noticed a significant increase in vertebral fractures comparing number of inpatients in 1991 and 1993: 0.64/1000 of men and 0.59/1000 of women in 1991 and 0.65/1000 in 1993 of both sexes. We did notice the important role of falls to fracture rate, as increase of hip and Colles' fractures increased more than 2 times in winter season. Evaluating our data, we make a conclusion, that the rate of osteoporotic fractures increased comparing 1991 and 1993: Colles' fracture- 1,5 times and hip fracture 2 times in women group, when in men's group Colles' fracture rate did not change significantly and hip fracture increased 2,9 times. The growing number of fracture's rate in population over 65 shows, that problem of involutional bone disorders exists in Lithuania also.

Aged↗

PubMed2000

Paleopathological and molecular evidence of human bone tuberculosis in Iron Age Lithuania.

Skeletal remains of two individuals, showing lesions suggestive of bone tuberculosis, from the archaeological sites of Marvele and Sukioniai in Lithuania were analyzed at the DNA level. The diagnosis of bone tuberculosis was confirmed in the remains from Marvele by amplifiying a 245-bp fragment of a repetitive insertion element-like sequence (IS 6110) of Mycobacterium tuberculosis DNA. This is direct evidence for the presence of tuberculosis in Lithuania at the beginning of the first millennium AD. The individual from Sukioniai was found to be tuberculosis-negative. No PCR product was obtained for the 245-bp target sequence or for a smaller 123-bp DNA fragment specific for Mycobacterium tuberculosis. However, amplifiable ancient DNA appeared to be present in the examined specimen as was shown by the results of the DNA-based sex identification, which indicated, consistent with the bone morphology, a male individual.

Adult↗