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[Health in the United Nations Convention on the Rights of the Child].

The United Nations Convention on the Rights of the Child is a document that secures the fundamental minimum needs of the child. It takes great consideration to support the perspective of the child in every respect. Most important of them are those, which influence the social process and fullness of child development: right to live, right to education and right to care. The attention is also paid to the child's right to health and health services. Lithuania joined the Convention in 1992. The review of literature on the United Nations Convention on the Rights of the Child is given. The perspectives and problems of implementation of Convention in Lithuania are discussed.

Adolescent↗

[Diversity of phytophagous and pathogens and their damage to mints (Mentha)].

UNLABELLED: The aim of this work was to estimate the phytopathologic condition of mints grown and self-growing in Kaunas Botanical Garden of Vytautas Magnus University and elsewhere in Lithuania; and to identify the specific constitution, the spread and damage of the main pests and disease agents. MATERIAL AND METHODS: Observations and examination were carried out with two local, four introduced mint species and with four hybrids in 1997-2003. We estimated the plant condition by identifying the intensity of the diseases and the abundance, spreading and damage of the pests. During the study we detected and identified the following pests--agents of diseases: Puccinia menthae, Erysiphe biocellata and Verticillium sp.; and phytophagous: Tetranychus urticae, Eupteryx atropunctata, Ovatus crataegarius, Polia persicariae, Agriotes lineatus, Chrysomela coerulans, Cassida viridis, Longitarsus lycopi. The most dangerous mint disease in Lithuania is rust; pests causing more harm are: Eupteryx atropunctata, Longitarsus lycopi. According to our data the least resistant species to most diseases and pests were Mentha arvensis and Mentha piperita, however separate samples of these species were exceptionally resistant. More resistant species was Mentha spicata and its hybrids.

Ecology↗

Alcohol consumption in Lithuanian school-aged children during 1994-2002.

UNLABELLED: Alcohol consumption becomes an important social and health problem among youth in many countries. Analysis of data on alcohol consumption behavior from World Health Organization Cross-National Study on Health Behavior in School-aged Children (HBSC) is presented in the article. This survey is carried out in majority of European countries including Lithuania. Aim of this study was to analyze features and trends of alcohol consumption among representative sample of 11, 13 and 15-year-old school children and to compare results with international data. METHODS: Patterns and trends of alcohol consumption were analyzed in three cross sectional questionnaire surveys of the representative sample of Lithuanian secondary school student's aged 11, 13 and 15 years in 1994, 1998 and 2002. Respectively, 5428, 4513 and 5645 respondents have filled in the questionnaires anonymously in the classroom according the methodology of international HBSC study. RESULTS: Boys were using alcohol on the regular basis (once a week or more often) more frequently than girls. Prevalence of regular alcohol consumption has increased from 9.4 to 13.6% in boys and from 4.2% to 6.5% in girls (p<0.05). Beer was the most popular alcohol drink among the students and was consumed respectively by 8.9%, 10.2% and 12.7% boys, and by 3.4%, 4.6%, 5.4% girls at least once per week. Prevalence of respondents who have reported the drunkenness (two or more times) has increased in boys from 13.3% to 30.1%, and in girls from 27.1% to 19.6% during period 1994-2002 (p<0.05). CONCLUSIONS: Trend of increase of alcohol consumption among school-aged children was observed in Lithuania during 1994-2002. Boys tend to be more frequent regular users of alcohol than girls. Alcohol consumption was significantly increasing with age. Alcohol use behaviors of Lithuanian school-aged children tend to be closer to countries of the Western Europe and the Nordic countries during the period of observation.

Age Factors↗

[Vegetables and fruits and risk of stomach cancer].

OBJECTIVE: Stomach cancer is the second common cause of death in Lithuania and most countries of the world. Nevertheless, there were no reports of epidemiological studies on stomach cancer in Lithuania. Therefore, a hospital-based case-control study has been carried out in order to assess the associations between vegetables and fruits and risk of stomach cancer. MATERIAL AND METHODS: Hospital-based case-control study included 379 cases with newly histologically confirmed diagnose of stomach cancer and 1137 controls that were free of cancer and stomach diseases. Cases and controls were matched by gender and age (+/-5 yr). Information on demographic variables, family history on cancer, life-style habits, such as diet, smoking, alcohol consumption, and physical activity was collected by a questionnaire. Conditional logistic regression was used to compute the odds ratio (OR) and their 95% confidence intervals (CI). RESULTS: After adjustment for other food items (vegetables, fruits, different types of meat, processed meat and fish, dairy and starchy products, coffee, green tea), that were related to outcome, smoking, alcohol use, family history on cancer, education level and residence, stomach cancer risk was inversely associated with consumption of raw vegetables such as cabbage (OR=0.24; 95% CI=0.10-0.57; > or =1-3 times/month vs. almost never), carrots (OR=0.42, 95% CI=0.20-0.86; 1-6 times/week vs. almost never) and garlic (OR=0.59, 95% CI=0.37-0.96; 1-6 times/week vs. almost never). Protective effect has been observed for intake of broccoli (OR=0.52, 95% CI=0.28-0.98; 1-4 times/week vs. < or =1-3 times/month). There were no statistically significant associations between stomach cancer risk and consumption of citrus or others fruits. In conclusion, higher consumption of raw vegetables such as cabbage, carrots, garlic as well as broccoli may decrease a risk of stomach cancer, whereas intake of citrus fruits has no relation with a reduced risk of the disease.

Adult↗

[Investigation of human papillomavirus, its types and variants].

Cervical cancer is one of the most common cancers in Lithuania. It is the fourth cancer in women according to the morbidity. The incidence rate of cervical cancer has been increasing in Lithuania since 1992. One of the important risk factor for cervical cancer is human papillomavirus (HPV) infection. The aim of this study is to compare the prevalence of human papillomavirus among cervical cancer patients and women with cervical intraepithelial lesions and healthy women, to determine its types and HPV 16 variants. Polymerase chain reaction and DNA sequencing were used for analysis of specimens taken from cervix uteri. Human papillomavirus was detected in 92.7% of cervical cancer patients and in 26.7% of control women (p<0.0001). It is important to notice that prevalence of HPV in women with high-grade squamous intraepithelial lesions was higher than in the control group. HPV 16 (55.8% in squamous cell carcinoma patients and 35.3% in cervical adenocarcinoma patients) and its European HPV 16 L83V variant were detected more frequently in cervical cancer patients. Studies on HPV, prevalence of its types and variants are very important for HPV based preventive strategies, especially for the vaccination.

Adenocarcinoma↗

Association between environment and psycho-emotional stress experienced at sea by Lithuanian and Latvian seamen.

This is the first scientific research in Lithuania and Latvia that involves a national cross-sectional study of the seamen of two different countries--Lithuania and Latvia--including the evaluation and comparison of seamen's working environment, lifestyle, health, the prevalence of health-damaging risk factors, as well as the causative relationships between the objective and subjective health evaluation and psycho-emotional stress experienced at sea. The aim of the study was to investigate the frequency and predictors of the psycho-emotional stress experienced at sea by Lithuanian and Latvian seamen. Beside the common statistical methods, the logistic stepwise regression analysis was used in order to find the risk factors of the self-rated stress and to correct the risk estimates for the confounding variables. Seamen of both countries indicated that they experienced psycho-emotional stress after, on the average, 2.7-2.8 months from the beginning of the voyage. More than one-half (57.5%) of Latvian seamen stated that they had experienced psycho-emotional stress, whereas the respective percentage of Lithuanian seamen was smaller (46.1%). The obtained findings showed that, having evaluated the influence of all the analyzed factors (industry-specific, health and lifestyle, medical and demographic), there was no significant difference between the seamen of the two countries concerning the experience of psycho-emotional stress on the ship. The following main prognostic factors related to the occurrence of psycho-emotional stress on the ship were determined: higher or specialized secondary education level (p<0.001), age of 35-44 or 45-54 years (p<0.01), 9-10 or 11-12 hours of work per day when being exposed to detrimental factors (p<0.01), the evaluation of one's health status as "average" (p<0.05), and evaluation of one's physical capacity as "quite good" or "average" (p<0.01). The occurrence of psycho-emotional stress was mostly influenced by work in the environment requiring increased visual strain (p<0.001) and vibration (p<0.05). We found that the following factors were associated with the occurrence of psycho-emotional stress on the ship: depression that occurred more frequently at sea than on shore (p<0.001), disturbed working and resting regimen due to time zone changes (p<0.001), and disturbed regular sexual life (p<0.001). Many of the unique aspects of seafaring are unchangeable. However, it possible to modify, supplement, or develop new strategies to reduce the impact these factors have on the health of individual seafarers.

Adult↗

The search for the criteria in reforming health care: evaluation of the spatial accessibility of primary healthcare service.

This article analyzes the spatial accessibility of primary healthcare services, i.e. the population's possibilities to receive healthcare services within an acceptable period of time in healthcare institutions situated in a certain territorial-administrative unit--the municipality. The aim of the study was to develop the technique for the quantitative evaluation of the spatial accessibility of primary healthcare services in different territories. The object of the study was the network of primary healthcare institutions and their subdivisions in the municipalities of Klaipeda, Taurage, and Vilnius districts. The methods of the study were geometrical modeling and applied graphics used for the quantitative determination of the ratios between the total zone area of the accessible primary healthcare institutions and the area of the respective municipal territory. The result of the study was the developed and proposed technique allowing for the evaluation of the spatial accessibility of primary healthcare institutions. The proposed technique of the evaluation of the spatial accessibility of primary healthcare services may be valuable in solving the problems of the development of primary healthcare institutions primarily in the rural regions of Lithuania. The quantitative expression of the evaluation could be used in decision-making related to investments into the development of the primary healthcare institution network in different administrational units of the country. The method of geometrical modeling involving the application of digital graphics may create preconditions for the creation of the geographical information system of the primary healthcare institution network in Lithuania.

Health Care Reform↗

Environmental and health monitoring in Lithuanian cities: exposure to heavy metals and benz(a)pyrene in Vilnius and Siauliai residents.

The Environmental and Health Monitoring program in the large cities of Lithuania is aimed at the evaluation of the population health status in terms of chemically induced diseases. During the 1991 to 1995 period, this program was carried out in two Lithuanian cities, Vilnius, the capital of the country, and Siauliai. Data on the chemical pollution of ambient air, soil, and drinking water and the morbidity were mapped. Risk zones of environmental pathology threat were defined within each city on the basis of the mapped data. Subsequently, chemical pollutants, namely, heavy metals and benz(a)pyrene, were determined in the biomedia of selected population groups in the risk zones. Exposure analysis of heavy metals (Pb, Cd, Ni, Cr, Cu, Zn) and benz(a)pyrene was carried out for standardized groups of children and pregnant women in the risk zones and in a relatively safe (control) zone. The evaluation of exposure to heavy metals was based on the levels found in blood, urine, and hair. Benz(a)pyrene was tested in urine samples. The obtained data are applied in the process of environmental health monitoring in the large cities of Lithuania.

Ambulatory Care Facilities↗

Neonatal end-of-life decision making: Physicians' attitudes and relationship with self-reported practices in 10 European countries.

CONTEXT: The ethical issues surrounding end-of-life decision making for infants with adverse prognoses are controversial. Little empirical evidence is available on the attitudes and values that underlie such decisions in different countries and cultures. OBJECTIVE: To explore the variability of neonatal physicians' attitudes among 10 European countries and the relationship between such attitudes and self-reported practice of end-of-life decisions. DESIGN AND SETTING: Survey conducted during 1996-1997 in 10 European countries (France, Germany, Italy, the Netherlands, Spain, Sweden, the United Kingdom, Estonia, Hungary, and Lithuania). PARTICIPANTS: A total of 1391 physicians (response rate, 89%) regularly employed in 142 neonatal intensive care units (NICUs). MAIN OUTCOME MEASURES: Scores on an attitude scale, which measured views regarding absolute value of life (score of 0) vs value of quality of life (score of 10); self-report of having ever set limits to intensive neonatal interventions in cases of poor neurological prognosis. RESULTS: Physicians more likely to agree with statements consistent with preserving life at any cost were from Hungary (mean attitude scores, 5.2 [95% confidence interval ¿CI¿, 4.9-5.5]), Estonia (4.9 [95% CI, 4.3-5.5]), Lithuania (5.5 [95% CI, 4.8-6.1]), and Italy (5.7 [95% CI, 5.3-6.0]), while physicians more likely to agree with the idea that quality of life must be taken into account were from the United Kingdom (attitude scores, 7.4 [95% CI, 7.1-7.7]), the Netherlands (7. 3 [95% CI, 7.1-7.5]), and Sweden (6.8 [95% CI, 6.4-7.3]). Other factors associated with having a pro-quality-of-life view were being female, having had no children, being Protestant or having no religious background, considering religion as not important, and working in an NICU with a high number of very low-birth-weight newborns. Physicians with scores reflecting a more quality-of-life view were more likely to report that in their practice, they had set limits to intensive interventions in cases of poor neurological prognosis, with an adjusted odds ratio of 1.5 (95% CI, 1.3-1.7) per unit change in attitude score. CONCLUSIONS: In our study, physicians' likelihood of reporting setting limits to intensive neonatal interventions in cases of poor neurological prognosis is related to their attitudes. After adjusting for potential confounders, country remained the most important predictor of physicians' attitudes and practices. JAMA. 2000;284:2451-2459.

Adult↗

Testicular cancer in nine northern European countries.

The incidence of testicular cancer was examined in the Nordic and Baltic countries, Poland and Germany by collaboration among 10 cancer registries. Population-based registers were used to analyze a total of 34,309 cases, diagnosed from the start of registration (varying from 1943 in Denmark to 1980 in Latvia and Lithuania) through 1989. An approximately 10-fold geographical variation was found in 1980, with the highest age-standardized incidence rate (7.8 per 10(5); world standard population) in Denmark and the lowest (0.9) in Lithuania. During the entire period of registration, incidence increased rapidly in all countries, by 2.3 to 3.4 per cent annually in the Nordic countries and by about 5 per cent in Poland and Germany; there was some evidence of a slower increase in Denmark and Poland after 1975. The rising trend was more pronounced for ages below 30. The age-specific incidence peaked in all countries at ages 25 to 34, but the geographical variation was considerable. Our data indicate that environmental influences on testicular cancer are strong. Exposure to causal factors mostly takes place early in life, shows substantial geographical variation, and increases over time, so that the age-standardized incidence doubles every 15 to 25 years. New aetiological hypotheses are needed to accommodate these salient features of the descriptive epidemiology, since risk factors considered so far cannot explain the observed pattern.

Adolescent↗

Changes in the use of antibacterial drugs in the countries of central and eastern Europe.

Use of systemic antibacterial drugs in the countries of central and eastern Europe (CCEE) has been studied using the defined daily doses (DDD) methodology. For the comparison, national wholesale data from Bulgaria, the Czech Republic, Estonia, Hungary, Lithuania, Slovakia, Slovenia and Romania for the years 1989 and 1992 were used, i.e. for the years before and after the rapid sociopolitical changes in these countries. Substantial differences in the patterns of antibacterial drug use between countries as geographically and economically similar as the CCEE were observed. The general sales of antibiotics varied almost twofold among the CCEE and had decreased in most of the CCEE during the study period. The proportion of tetracyclines in the sales of 1992 ranged from 10% in Slovenia to 49% in Estonia, and that of broad-spectrum penicillins from 6% in Estonia to 40% in Slovenia. The use of narrow-spectrum penicillins varied within the range of 4% in Bulgaria to 38% in Slovakia, and had decreased during the study years in all countries. Aminoglycosides accounted for 5-12% of all antibacterials in Bulgaria, Estonia, Lithuania, Romania and Slovakia in the study period, and these countries, with the exception of Slovakia, also had a high consumption of chloramphenicol. In 1992, by far the most popular antiinfectives in the CCEE were doxycycline, ampicillin and co-trimoxazole, which ranked among the top ten drugs in all countries studied.(ABSTRACT TRUNCATED AT 250 WORDS)

Ampicillin↗

Tuberculosis trends in eastern Europe and the former USSR.

The aim of this paper is to assess trends in tuberculosis morbidity and mortality in the countries of Eastern Europe and the former USSR. Data on morbidity and mortality were obtained from reports of the Ministries of Health, a 1992 WHO questionnaire, national tuberculosis associations, and other sources. The quality of surveillance of tuberculosis cases differs widely between countries. Ranging from 19 to 80 per 100,000 population in 1990-1992, tuberculosis notification rates of most Eastern European and former USSR countries are higher than those of Western European countries. The lowest tuberculosis notification rate is reported in the Czech Republic, while the highest are reported in Romania and Kazakhstan. While in Albania, Croatia and Slovenia notification rates have continued to decline, in the remaining countries of Eastern Europe the declining trend has recently stopped. Nevertheless, countries such as the Czech Republic, Hungary, Poland and the Slovak Republic have experienced a distinct rate decrease when the 3-year average rate around 1985 is compared to that around 1990, despite the very recent levelling-off or increase. In Romania, the previous decline in notification rate ended in 1985 and in the period 1986-1992 an average 5.4% annual increase was observed. In this country, two-thirds of all cases still occur among young adults. Among the Baltic countries of the former USSR, the declining trend continues in Estonia, whereas in Latvia and Lithuania notification rates decreased less markedly from 1985 to 1990 than in the first half of the 1980s. Among the other European countries of the former USSR, Russia and Ukraine had a slow decline in the first half of the 1980s and a more pronounced one from 1985 to 1990. During the latter period of time, in Belarus and Moldova the decrease has been steeper. In the Caucasian countries of the former USSR, where underreporting and low case-finding are recognized, case rates have stabilized in Armenia, while in Azerbaijan and Georgia there was a decrease from 1985 to 1990. Among the Asian countries of the former USSR, Kazakhastan and Tajikistan reported a lower decline in case rates from 1985 to 1990 than from 1980 to 1985. Kyrgyzstan, Turkmenistan, and Uzbekistan reported increases in notification rates from 1985 to 1990: in Turkmenistan an average 5.5% annual increase in rate was observed between 1987 and 1991. Tuberculosis mortality is steadily increasing in Romania, Armenia, Kyrgyzstan, Latvia, Lithuania, Moldova, and Turkmenistan, while no decline is seen in most of the other countries of Eastern Europe and the former USSR.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗

Distribution and sources of (129)I in rivers of the Baltic region.

The concentration of (129)I was measured in 54 river waters discharging into the Baltic Sea from Sweden, Finland, Estonia, Latvia, Lithuania, Poland and Germany. Sample collection was performed during a well-bracketed time interval (June-July 1999), thus allowing comparison of the rivers over a wide latitude range without the effect of long temporal spread. Although there is no direct input of anthropogenic (129)I in the watersheds, the concentration of the isotope is about two to three orders of magnitude higher than the expected pre-nuclear era natural values in the rivers of Finland and northern Sweden, and in the rivers of southern Sweden, Lithuania, Estonia, Latvia, Poland and Germany; the (129)I concentration may reach five orders of magnitude higher. Furthermore, there are significant correlations between the (129)I concentration and latitude and/or distance from the North Sea and between (129)I and Cl. These findings suggest seawater as a main source of (129)I to the rivers through atmospheric transport. Of the many chemical parameters investigated, the pH may account for some of the variability in (129)I concentrations of the rivers. The contribution from nuclear weapon tests and the Chernobyl accident to the riverine (129)I is insignificant compared to the releases from the nuclear fuel reprocessing facilities. The total flux of (129)I by rivers to the Baltic Sea and related basins represents minor amounts of the isotope pool in these marine waters. External radioactivity hazards from (129)I are considered to be negligible in the Baltic region. However, as the main (129)I intake to the human body is likely through water, due to the large amount of daily water consumption, more concern should be given to internal radioactivity hazard that may be associated with the isotope's localized elevated concentration in the human organs.

Baltic States↗

Probabilistic indicators of atmospheric transport for regional monitoring and emergency preparedness systems.

In this paper, following a methodology developed within the "Arctic Risk" Project of the Nordic Arctic Research Programme, several probabilistic indicators to evaluate the risk site possible impact on the geographical regions, territories, countries, counties, cities, etc., due to atmospheric transport from the risk site region were suggested. These indicators-maximum possible impact zone, maximum reaching distance, and typical transport time-were constructed by applying statistical methods and using a dataset of isentropic trajectories originated over the selected nuclear risk site (Ignalina nuclear power plant, Lithuania) during 1991-1996. For this site, the areas enclosed by isolines of the maximum possible impact zone and maximum reaching distance indicators are equal to 42 x 10(4) and 703 x 10(4) km(2), respectively. The maximum possible impact zone's boundaries are more extended in the southeast sector from the site and include, in particular, Latvia, Lithuania, Belarus, and several western regions of Russia. The maximum reaching distance's boundaries are twice more extended in the eastern direction from the site (reaching the Caspian Sea) compared with the western direction. The typical transport time to reach the southern territories of Sweden and Finland, northern regions of Ukraine, and northeast of Poland is 1 day. During this time, the atmospheric transport could typically occur over the Baltic States, Belarus, and western border regions of Russia, and central aquatoria of the Baltic Sea. Detailed analysis of temporal patterns for these indicators showed importance of the seasonal variability.

Air Movements↗

New patterns of Trichinella infection.

Human and animal trichinellosis should be considered as both an emerging and reemerging disease. The reemergence of the domestic cycle has been due to an increased prevalence of Trichinella spiralis, which has been primarily related to a breakdown of government veterinary services and state farms (e.g., in countries of the former USSR, Bulgaria, Romania), economic problems and war (e.g., in countries of the former Yugoslavia), resulting in a sharp increase in the occurrence of this infection in swine herds in the 1990s, with a prevalence of up to 50% in villages in Byelorussia, Croatia, Latvia, Lithuania, Romania, Russia, Serbia, and the Ukraine, among other countries. The prevalence has also increased following an increase in the number of small farms (Argentina, China, Mexico, etc.) and due to the general belief that trichinellosis was a problem only until the 1960s. The sylvatic cycle has been studied in depth at both the epidemiological and biological level, showing the existence of different etiological agents (Trichinella nativa, Trichinella britovi, Trichinella murrelli, Trichinella nelsoni) in different regions and the existence of "new" transmission patterns. Furthermore, the role of game animals as a source of infection for humans has greatly increased both in developed and developing countries (Bulgaria, Canada, Lithuania, some EU countries, Russia, USA, etc.). The new emerging patterns are related to non-encapsulated species of Trichinella (Trichinella pseudospiralis, Trichinella papuae, Trichinella sp.), infecting a wide spectrum of hosts (humans, mammals including marsupials, birds and crocodiles) and to encapsulated species (T. spiralis, T. britovi, and T. murrelli) infecting herbivores (mainly horses). The existence of non-encapsulated species infecting mammals, birds and crocodiles had probably remained unknown because of the difficulties in detecting larvae in muscle tissues and for the lack of knowledge on the role of birds and crocodiles as a reservoir of Trichinella. On the other hand, it is not known whether horse and crocodile infections existed in the past, and their occurrence has been related to improper human behavior in breeding. The problem of horse-meat trichinellosis is restricted to France and Italy, the only two countries where horse-meat is eaten raw, whereas mutton and beef have been found to be infected with Trichinella sp. only in China.

Alligators and Crocodiles↗

Comparison of the Micro-Nutrica Nutritional Analysis program and the Russian Food Composition Database using data from the Baltic Nutrition Surveys.

OBJECTIVE: The objective of this study was to compare the nutrient content of foods and diets based on data from two food composition databases used in the Baltic Nutrition Surveys (conducted in Estonia, Latvia and Lithuania in 1997): an adapted version of the Finnish Micro-Nutrica Nutritional Analysis program (used in Estonia) and the Russian Institute of Nutrition Food Composition Database (used in Latvia and Lithuania). DESIGN: The adapted Micro-Nutrica and Russian databases were used to estimate the energy and nutrient (protein, fat, carbohydrate, vitamin C, calcium and iron) content of 15 common foodstuffs in the region and the nutrient intakes of 32 Latvian respondents (based on 24-h recalls). Differences between databases were estimated. RESULTS: There were discrepancies in the energy and nutrient content of the 15 selected foods using the two databases. The adapted Micro-Nutrica database generally gave a lower energy content than the Russian database (median: -6%), and a lower fat content for typically fat-rich foods. Intakes of energy, fat, carbohydrate and calcium by the 32 selected respondents were significantly lower when the Micro-Nutrica database was used. Differences were particularly high for fat (difference=-23.5%, 95% confidence interval=-31.1 to -15.8%, P<0.0001). CONCLUSIONS: The results suggest that reported comparisons of nutrient intakes in the Baltic countries should be treated with caution and that more research is needed for the development of comparable national databases in the region. Potential differences between databases should be investigated early when international surveys of dietary intake are being planned.

Baltic States↗

The status of antimicrobial resistance of Helicobacter pylori in eastern Europe.

OBJECTIVE: To evaluate the primary, secondary and combined resistance to five antimicrobial agents of 2340 Helicobacter pylori isolates from 19 centers in 10 countries in eastern Europe. METHODS: Data were available for centers in Bulgaria, Croatia, the Czech Republic, Estonia, Greece, Lithuania, Poland, Russia, Slovenia and Turkey. Susceptibility was tested by agar dilution (seven countries), E test (five countries) and disk diffusion (three countries) methods. Resistance breakpoints (mg/L) were: metronidazole 8, clarithromycin 1, amoxicillin 0.5, tetracycline 4, and ciprofloxacin 1 or 4 in most centers. Primary and post-treatment resistance was assessed in 2003 and 337 isolates respectively. Results for 282 children and 201 adults were compared. RESULTS: Primary resistance rates since 1998 were: metronidazole 37.9%, clarithromycin 9.5%, amoxicillin 0.9%, tetracycline 1.9%, ciprofloxacin 3.9%, and both metronidazole and clarithromycin 6.1%. Isolates from centers in Slovenia and Lithuania exhibited low resistance rates. Since 1998, amoxicillin resistance has been detected in the southeastern region. From 1996, metronidazole resistance increased significantly from 30.5% to 36.4%, while clarithromycin resistance increased slightly from 8.9% to 10.6%. In centers in Greece, Poland, and Bulgaria, the mean metronidazole resistance was slightly higher in adults than in children (39% versus 31.2%, P > 0.05); this trend was not found for clarithromycin or amoxicillin (P > 0.20). Post-treatment resistance rates exhibited wide variations. CONCLUSIONS: In eastern Europe, primary H. pylori resistance to metronidazole is considerable, and that to clarithromycin is similar to or slightly higher than that in western Europe. Resistance to amoxicillin, ciprofloxacin and tetracycline was detected in several centers. Primary and post-treatment resistance rates vary greatly between centers.

Adult↗

Epidemiology of insulin-dependent diabetes mellitus around the Baltic Sea. The DIABALT Study Group.

Great spatial variation in the incidence of IDDM is found among countries around the Baltic Sea, a relative small area on the global scale. We present recent data on IDDM incidence from countries around the Baltic Sea, monthly variation and time trends in incidence from the early 1980s to the early 1990s. The change in IDDM incidence was calculated from logarithms of incidence using linear regression. The incidence was high in the countries to the north and west from the Baltic Sea, being the highest in Finland (35 per 100,000/year) followed by Sweden (26), Denmark (22) and Norway (21). In the countries on the eastern and southern coast of the Baltic Sea the incidence was markedly lower, in Estonia the incidence (10) was the highest within these countries, though slightly less than one third of that in Finland, while it was in Lithuania 7, Latvia 7 and Poland 6. There was an increasing trend in incidence of IDDM in Finland, Norway and Poland. In Sweden the incidence increased from 1978 to 1984, but since then the trend has been flat. In Estonia, Latvia and Lithuania, no significant change in incidence was seen. The reasons for large differences observed in the incidence of IDDM between countries around the Baltic Sea area are unknown, but a complex interaction between genetic and environmental risk factors that can vary in different ethnic, socio-economic and cultural settings play an important role in this variation.

Adolescent↗