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First-time dental care and the most recent dental treatment in relation to utilisation of dental services among dentate elderly patients in Lithuania.

OBJECTIVES: To describe the initial dental treatments of Lithuanian dentate elderly patients and the content of the most recent treatment in relation to their dentist-visiting behaviour. MATERIALS AND METHODS: A cross-sectional questionnaire study was carried out at two public dental offices in Kédainiai, Lithuania, among dentate patients aged 60+ years. A self-administered questionnaire covered first-time dental care, the most recent dental treatment, check-up behaviour, interval since the most recent dental visit, and number of teeth. Age, gender and education served as background information. Statistical evaluation was by chi-squared test, anova and logistic regression for odds ratio (OR). RESULTS: In all, 174 dentate elderly responded, mean age being 69.2 (SD = 6.6) years. The mean age at the first visit was 16.3 years [95% confidence interval (CI) 14.9-17.6]. Regular dental check-ups were reported by 30%, and 36% had visited a dentist within the past 12 months. As to the content of the most recent treatment, 78% of the elderly reported filling therapy, 50% endodontics, 48% tooth extraction, 21% radiography, 10% cleaning or scaling and 6% polishing of fillings. Those going for check-ups were more likely to report diagnostic (OR 1.9; 95% CI 1.1-2.8; p = 0.01) and preventive (OR 4.8; 95% CI 2.5-9.0; p = 0.002) treatment when analysed by a logistic regression model, controlling for age, gender, education and number of teeth. CONCLUSIONS: Check-up-orientated utilisation of dental services should be encouraged among the Lithuanian elderly. Dentists and health officials should place greater emphasis on prevention.

Adolescent↗

Lessons from Lithuania: rethinking public health training.

Lithuania faces stark problems that are familiar to most countries in the former Soviet Union: high morbidity and mortality rates, pollution, an unstable economy, and rapid changes in the financing and organisation of health care. In this environment Moore and Dixon visited Kaunas Medical Academy to help identify how training in public health medicine could contribute towards improving the health of the population. Although over 200 hours are devoted to public health training for medical undergraduates, teaching is unfocused, fragmented, and includes little epidemiology--the core subject for public health physicians. Teaching is mainly through long lectures with few group discussions. Student participation and motivation are low. As well as recommending redesign of the curriculum, Moore and Dixon suggested training in teaching methods for teachers. They also suggested that postgraduate training in public health should begin and should be targeted at hospital managers, teaching staff, and existing public health physicians.

Curriculum↗

Prevalence and severity of dental caries in 12-year-old children in Kaunas, Lithuania 1995.

In order to evaluate suitable strategies for control of dental caries, a longitudinal study of caries progression has been initiated among 12-year-old children in Kaunas, Lithuania. The aim of the present paper was to describe the baseline caries situation in a sample of 12-year-olds, who had been examined using caries diagnostic criteria which differentiate between active and inactive caries lesions at both the cavitated and non-cavitated levels. The mean fluoride concentration in the drinking waters of Kaunas is 0.16 mg/l. A total of 889 children in the 6th grade from seven selected schools were examined. Each tooth surface of all permanent teeth was classified according to one of the following criteria: 0 = sound; 1 = active, surface intact; 2 = active, surface discontinuity; 3 = active, cavity; 4 = inactive, surface intact; 5 = inactive, surface discontinuity; 6 = inactive, cavity; 7 = filled; 8 = filled with inactive lesion; 9 = filled with active lesion; X = extracted. Distinction between active and inactive lesions was made on the basis of a combination of visual and tactile criteria. Virtually all children (99.7%) had experienced at least 1 DMF surface. The mean DMFS was 15.8. Half of the mean caries experience consisted of surfaces with active lesions (7.9), of which two thirds (4.9) were non-cavitated. The mean number of surfaces with non-cavitated inactive lesions was 4.4. The mean DMFT constituted 7.9; 95% of all first molars were affected, followed by the second molars (61%). A comparison of the caries profile according to the present caries diagnostic criteria with those recommended by WHO revealed that the WHO criteria yielded much lower DMFS and DMFT values, because this scoring system does not include non-cavitated caries lesions. The high level of non-cavitated active caries lesions suggests that in this population caries may to a large extent be controlled by simple preventive measures including use of topical fluorides.

Adolescent↗

Drugs in the postsocialist transitions of Estonia, Latvia, Lithuania and Poland.

The article discusses problems related to illicit drugs in Poland, Lithuania, Latvia and Estonia against the background of the postsocialist transitions of the 1990s. Besides the drug problem, the political and market reforms of the 1990s were accompanied by a surfacing of a variety of social problems, some of which had already been present during the authoritarian socialist regimes. Gaining reliable and comparable statistics on drug-related harm has become very difficult due to changes in treatment system and health statistics. Nevertheless, all available evidence suggests that the use of illicit drugs has grown rapidly in all four countries, it now being close to the Western European level. As a result of international impulses rather than domestic interest, strictly restrictive drug policies have been adopted. Drug problems are aggravated by a marginalisation of a large part of the populations. Accordingly, their reduction may require a more general revision of the four countries' economic and social policies.

Estonia↗

The emigration potential of Czechoslovakia, Hungary, Lithuania, Poland and Russia: recent survey results.

The author reviews recent evidence concerning the emigration potential of Russia and Eastern Europe, using data from a 1991 survey of 4,269 respondents. "It is demonstrated that the proportion of adults wishing to emigrate from each of these countries in February 1991 varied from a low of 2 per cent in Lithuania to a high of 13 per cent in Poland. Total emigration potential from the region is estimated to have been between 10.2 and 16.7 million....A multiple regression analysis indicates that age and pessimism concerning democracy are the main factors that were independently associated with desire to emigrate."

Age Factors↗

Industrial waste minimization--experience from Lithuania.

Waste represents the loss of both material and energy resources. Because excessive waste generation is a symptom of inefficient production processes, low durability of goods and unsustainable consumption patterns, waste quantities can be considered as an indicator of how efficiently society uses raw materials. Therefore, good waste management begins with preventing waste from being generated. The objective of this paper is to present the work related to waste minimization in Lithuania by introducing successful examples from industry, to bring ideas and inspiration to authorities, companies, and others working in the field of waste minimization. The paper is supporting EU waste policy manifested in the EU waste strategy and the proposed Sixth Environmental Action Programme. Many enterprises are still unaware of the full costs of waste management. Therefore, by applying the methodology presented in the paper, companies could make substantial reductions in their waste, and therefore, disposal costs. Waste minimization (WM) often results in substantial savings through reduced purchasing costs and more efficient practices. It also has wide environmental benefits such as reduced energy consumption and less environmental pollution, conservation of natural resources and extension of valuable landfill capacity. Therefore, waste prevention should have the highest priority in waste strategies, as this is the only way to stop the growth of the amount of waste and reduce the loss of resources (EUC Bulletin 12, 1996).

Conservation of Natural Resources↗

Morbidity and mortality in Estonia, Latvia and Lithuania in the 1980's.

The purpose of the present study was to examine the general morbidity and mortality rates in the three Baltic republics--Estonia, Latvia and Lithuania during a decade before the collapse of the Soviet Union. Official statistical data were used to compare morbidity and mortality rates. A method of standardization and life table functions were employed. Soviet morbidity statistics were predominantly descriptive, and based mainly on crude rates registered cases of illness during a year per 100,000 population. The death rates during the Soviet period are a better indicator of the health of the populations than more specific health indicators. A general deterioration of the ecological, social and economic situation in the Baltic republics at the end of the 1980s and early 1990s may have resulted in the mortality rising and aborted any trends to increasing life expectancy in the next few years thus requiring more radical reforms in health and social policy. The study demonstrates a noticeable difference in mortality rates between demographic and socio-economic groups in the Baltic states.

Absenteeism↗

Clinical presentation of pertussis in fully immunized children in Lithuania.

BACKGROUND: In Lithuania, the vaccination coverage against pertussis is high. Nevertheless, there is a significant increase in pertussis cases in fully immunized children. The aim of our study was to determine the frequency of classical symptoms of laboratory confirmed pertussis and describe its epidemiology in children fully vaccinated against pertussis. METHODS: From May to December 2001, 70 children aged 1 month to 15 years, suffering from prolonged cough were investigated in the Centre of Paediatrics, Vilnius University Children's Hospital. The collected information included personal data, vaccination history, clinical symptoms of the current illness, and treatment before hospitalization. At the admission to the hospital blood samples were taken from all studied children for Bordetella pertussis IgM and IgA. RESULTS: A total of 53 (75.7%) of the 70 recruited patients with prolonged cough showed laboratory evidence of pertussis. 32 of them were fully vaccinated with whole cell pertussis vaccine (DTP). The age of fully vaccinated patients varied from 4 to 15 years (average 10.9 +/- 3.1; median 11). The time period between the last vaccination dose (fourth) and the clinical manifestation of pertussis was 2.6-13 years (average 8.9 +/- 3.0; median 9). More than half of the children before the beginning of pertussis were in contact with persons suffering from long lasting cough illness in the family, school or day-care center. The mean duration from onset of pertussis symptoms until hospitalization was 61.4 +/- 68.3 days (range, 7 to 270 days; median 30). For 11 patients who had had two episodes (waves) of coughing, the median duration of cough was 90 days, and for 21 with one episode 30 days (p < 0.0002). Most of the children (84.4%) had paroxysmal cough, 31.3% had post-tussive vomiting, 28.1% typical whoop, and 3.1% apnea. Only 15.6% children had atypical symptoms of pertussis. CONCLUSION: Fully vaccinated children fell ill with pertussis at the median of 11 years old, 9 years following pertussis vaccination. More than half of the children could catch pertussis at home, at school or day-care center. Clinical picture of pertussis in previously immunized children is usually characterized by such classical symptoms as prolonged and paroxysmal cough, rarely by whopping and post-tussive vomiting, and very rarely by apnea.

Adolescent↗

Family time, parental behaviour model and the initiation of smoking and alcohol use by ten-year-old children: an epidemiological study in Kaunas, Lithuania.

BACKGROUND: Family is considered to be the first and the most important child development and socialization bond. Nevertheless, parental behaviour model importance for the children, as well as family time for shared activity amount influence upon the child's health-related behaviour habit development has not been yet thoroughly examined. The aim of this paper is to indicate the advanced health-hazardous behaviour modelling possibilities in the families, as well as time spent for joint family activities, and to examine the importance of time spent for joint family activities for the smoking and alcohol use habit initiation among children. METHODS: This research was carried out in Kaunas, Lithuania, during the school year 2004-2005. The research population consisted of 369 fifth-grade schoolchildren (211 (57.2%) boys and 158 (42.8%) girls) and 565 parents: 323 (57.2%) mothers and 242 (48.2%) fathers. The response rate was 80.7% for children; 96.1% and 90.6% for mothers and fathers correspondingly. RESULTS: Eating a meal together was the most frequent joint family activity, whereas visiting friends or relatives together, going for a walk, or playing sports were the most infrequent joint family activities. More than two thirds (81.5%) of parents (248 (77.0%) mothers and 207 (85.9%) fathers (p < 0.05)) reported frequenting alcohol furnished parties at least once a month. About half of the surveyed fathers (50.6%) together with one fifth of the mothers (19.9%) (p < 0.001) were smokers. More frequently than girls, boys reported having tried smoking (6.6% and 23.0% respectively; p < 0.001) as well as alcohol (31.16% and 40.1% respectively; p < 0.05). Child alcohol use was associated both with paternal alcohol use, and with the time, spent in joint family activities. For instance, boys were more prone to try alcohol, if their fathers frequented alcohol furnished parties, whereas girls were more prone to try alcohol, if family members spent less time together. CONCLUSION: Joint family activity time deficit together with frequent parental examples of smoking and alcohol use underlie the development of alcohol and smoking addictions in children to some extent. The above-mentioned issues are suggested to be widely addressed in the comprehensive family health education programs.

Adult↗

The factors associated to psychosocial stress among general practitioners in Lithuania. Cross-sectional study.

BACKGROUND: There are number of studies showing that general practice is one of the most stressful workplace among health care workers. Since Baltic States regained independence in 1990, the reform of the health care system took place in which new role and more responsibilities were allocated to general practitioners' in Lithuania. This study aimed to explore the psychosocial stress level among Lithuanian general practitioner's and examine the relationship between psychosocial stress and work characteristics. METHODS: The cross-sectional study of 300 Lithuanian General practitioners. Psychosocial stress was investigated with a questionnaire based on the Reeder scale. Job demands were investigated with the R. Karasek scale. The analysis included descriptive statistics; interrelationship analysis between characteristics and multivariate logistic regression to estimate odds ratios for each of the independent variables in the model. RESULTS: Response rate 66% (N = 197). Our study highlighted highest prevalence of psychosocial stress among widowed, single and female general practitioners. Lowest prevalence of psychosocial stress was among males and older age general practitioners. Psychosocial stress occurs when job demands are high and job decision latitude is low (chi2 = 18,9; p < 0,01). The multivariate analysis shows that high job demands (OR 4,128; CI 2,102-8,104; p < 0,001), patient load more than 18 patients per day (OR 5,863; CI 1,549-22,188; p < 0,01) and young age of GP's (OR 6,874; CI 1,292-36,582; p < 0,05) can be assigned as significant predictors for psychosocial stress. CONCLUSION: One half of respondents suffering from work related psychosocial stress. High psychological workload demands combined with low decision latitude has the greatest impact to stress caseness among GP's. High job demands, high patient load and young age of GP's can be assigned as significant predictors of psychosocial stress among GP's.

Adult↗

HIV infection and sexually transmitted infections in Lithuania.

Lithuania is a small country with a population of 3.7 million. It has recently been released from the yoke of Soviet rule. HIV infection was first identified in 1988 and while the numbers of cases are small, the incidence is beginning to rise precipitously. A National AIDS Centre has been established in the capital, Vilnius, and a nationwide epidemiological survey is underway. Efforts are being made to prevent HIV infection. Sixty one per cent of notified cases of HIV infection are in Klaipéda, a port city adjacent to the Kaliningrad region and the predominant mode of transmission is by intravenous drug use. The majority of cases of AIDS, however, are seen in Vilnius. Sexually transmitted infections (STIs) are poorly controlled and there is no national control strategy. While the incidence of gonorrhoea is declining, new cases of syphilis have been on the increase, reaching 101.4 cases per 100,000 of the population. Cases of congenital syphilis are still seen.

Adolescent↗

Sex attractants for six moth species of the families Brachodidae, Choreutidae and Tineidae from Kazakhstan and Lithuania.

Sex attractants were established for one Brachodidae, three Choreutidae and two Tineidae moth species during field screening tests with (2E,13Z)-octadecadien-1-al, (2E,13Z)-, (3E,13Z)-, (3Z,13Z)-octadecadien-1-ols and their acetates (2E,13Z-18:Ald, 2E,13Z-, 3E,13Z-, 3Z,13Z-18:OH/OAc) as well as of binary mixtures of these compounds in West-Kazakhstan and Lithuania. Males of Brachodes appendiculata were attracted by 3E,13Z-18:OAc, Prochoreutis ultimana and P. myllerana by 2E,13Z-18:OH, Monopis palidella by 2E,13Z-18:Ald and Triaxomera fulvimitrella by binary mixtures of 3Z,13Z-18:OAc with either 3E,13Z-18:OH in the ratio of 5:5 or 3Z,13Z-18:OH in the ratio of 9:1 (v/v). The 3-component mixture composed of 2E,13Z-18:OH, 3Z,13Z-18:OH and 2E,13Z-18:Ald in the ratio 1:1:1 was developed to attract Prochoreutis sehestediana males. Attraction antagonists for B. appendiculata, P. ultimana and M. palidella were shown.

Animals↗

A study of IQ in Lithuania.

Data for the Colored Progressive Matrices were collected for a sample of 259 8- to 12-yr.-old children in Lithuania in 1999. In relation to the British 1979 standardization sample the mean IQ of the Lithuanian children was 92.2. Adjusted for the estimated secular increase of intelligence in Britain, the Lithuanian mean IQ is estimated at 90.

Child↗

Ratings of contracting infectious diseases and of the risk of sexual HIV transmission by health care students from Germany, Lithuania, and Namibia.

In Germany, Lithuania, and Namibia different types of the HIV epidemic are present. HIV testing of health care students and their ratings of the risk of sexually acquired HIV infections and factors influencing the risk of contracting infectious diseases were analyzed. 182 German medical and dental students, 176 Lithuanian medical students, and 135 Namibian student nurses participated by completing anonymous questionnaires. The Namibian student nurses rated sexual HIV transmission risks higher than the Lithuanian and German medical students did. In general, the Lithuanian medical students rated risks of HIV transmission lowest, compared to the students in the other two samples. Risk behavior and environmental factors were most emphasized by the three student samples as having an influence on the risk of contracting infectious diseases. Thus, national prevalence of HIV influences ratings of sexual HIV transmission risks, while rating of factors influencing the risk of contracting infectious diseases are similar.

Adolescent↗

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↗

Psychosocial factors at work and myocardial infarction among men in Kaunas, Lithuania.

OBJECTIVES: The association between job demand and job control and first nonfatal myocardial infarction was studied among the 25- to 64-year-old male population in Kaunas, Lithuania. METHODS: A translation of the Swedish version of the demand-control questionnaire was used. Both psychosocial work characteristics as independent risk factors and the possible effects of traditional risk factors (smoking, arterial hypertension, overweight) were analyzed in a case-control study among 203 men diagnosed in 2001-2002 with a first nonfatal myocardial infarction (cases) and 287 men randomly selected as controls. A logistic regression analysis was used to estimate the odds ratio for developing myocardial infarction in relation to self-reported job demand and job control. Possible confounders (age, marital status, education, type of occupation, smoking, blood pressure, body mass index) were controlled. RESULTS: The adjusted odds ratio was 0.56 [95% confidence interval (95% CI 0.37-0.85)] and 1.53 (95% CI 1.04-2.38), for demand and control, respectively. That for workers with low demand and low control was 1.89 (95% CI 0.99-3.60) as compared with low demand and high control. The risk of myocardial infarction for men in passive jobs (low demand and low control) was twofold that of the other respondents. CONCLUSIONS: The association between low job control and the risk of myocardial infarction was found to be consistent with research in western populations. In contradiction, however, to findings in western studies, low demand, rather than high demand proved to be a risk factor for 25- to 64-year-old men. Employees in passive jobs had the highest risk.

Adult↗

Infant BCG vaccination study in Lithuania.

SETTING: Infants identified in maternity hospitals in Vilnius, Lithuania. OBJECTIVES: To test the capacity of the BCG vaccine, Danish strain 1331 (Danish vaccine), to induce tuberculin reactivity and scar formation in neonates compared to the WHO International Reference Preparation of BCG (IRP vaccine), and to study the effect of dose and of age at vaccination. DESIGN: A randomized four-armed study: 1) normal dose, 0.05 ml Danish vaccine given to neonates at birth, 2) half the normal dose of Danish vaccine given at birth, 3) IRP vaccine given at birth at normal infant dose, and 4) the normal infant dose of Danish vaccine given at 3 months of age. RESULTS: Larger tuberculin reactions, as well as an increased frequency and larger scars, were seen when Danish vaccine was given at 3 months of age in comparison to neonatal vaccination. Halving the dose resulted in smaller reactions, but the difference was not significant. The IRP vaccine resulted in borderline significantly larger reactions in comparison to the Danish vaccine. The number of infants receiving very early vaccination (0-2 days) was not evenly distributed in all groups, however, which is believed to explain the observed difference.

BCG Vaccine↗

Health policy development in Lithuania.

The process of formulating a national health policy in Lithuania, a country in transition, has undergone several stages. Despite the existence of a national critical mass of professionals who understand the major principles of health policy development and who have a solid database to scientifically back the suggested decisions, and despite general acceptance by the public of the broader dimensions of health, the actual process of developing health policy is still facing considerable difficulty. Many factors obstruct this process, such as the inflexibility and resistance of the medical profession, traditions from the previous health service model and an extremely difficult economic situation. Nevertheless, one of the most important factors is the frequent change of government and, subsequently, of ministers of health, which makes continuity difficult. Fortunately, however, in contrast to the political level, the health professionals involved in health policy development and implementation assure at least one level of this necessary continuity. As a result of continuous efforts by the Health Reform Management Group and research and education institutions, and with the constant support of WHO, a policy and strategy for health for all continues to be developed, and the groundwork is being laid for improved dialogue and participation.

Cooperative Behavior↗