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All the former Soviet countries are making efforts to reform psychiatry and adopt generally acknowledged international standards. Key issues of reform are changing the role of professional associations and the development of psychiatric legislation. This process is illustrated by the activities of psychiatric associations in Ukraine, Lithuania and Russia.
In an earlier historical cohort study on the post-concussion syndrome (PCS) in Lithuania, a country in which there are few confounding factors, the validity of this condition as a disease entity could not be confirmed. In order to register the post-traumatic symptoms, the influence of sociodemographic factors, and the effect of expectation on these symptoms more reliably, we performed a controlled prospective study. Three hundred subjects with concussion were followed up with repeated questionnaires for 1 year. For each study subject, a sex- and age-matched control person with minor non-head injury was identified. These controls received similar questionnaires. Headache both after 3 months and after 1 year did not differ significantly between the head-injured participants and the non-head-injured controls. Several other symptoms attributed to PCS did not differ significantly between the groups after 3 months. After 1 year the vast majority of symptoms did not differ significantly. Exceptions were slightly significant differences concerning memory problems, concentration problems, dizziness and tiredness. These differences were insignificant when analysing symptoms in unmarried and/or people with lower education, separately. No relationship between cognitive dysfunction and the severity of concussion was found. Although the possibility of a mild organic brain injury cannot be completely ruled out, our results cast doubt on the validity of PCS as a useful clinical entity, at least for head injuries with loss of consciousness for <15 min. Sociodemographic factors and expectation seem to influence reporting of symptoms after concussion.
OBJECTIVES: This study describes determinants of dropout in a three-year community intervention trial of the effects of sugar-substituted chewing gums on caries progression rates. METHODS: A total of 602 children aged 9-14 years from 28 school classes in five secondary schools in Kaunas, Lithuania, were given a clinical and radiographic baseline caries examination. The schools were assigned randomly to one of the following interventions: sorbitol/carbamide gum, sorbitol gum, xylitol gum, placebo gum, or no gum. Children in the four intervention schools were asked to chew at least five pieces of chewing gum per day, preferably after meals. The children were reexamined clinically after one, two, and three years of study, and radiographically after three years. RESULTS: A total of 33 children (6%) had dropped out before the one-year clinical examination, an additional 29 children (5%) dropped out before the two-year examination, and a further 108 children (18%) dropped out before the final three-year clinical examination. A total of 230 children (39%) were not available or refused to participate in the three-year radiographic examination. Analyses using random effect logit models showed that, irrespective of time of follow-up, most of the cluster variation in dropout was related to school classes within the primary randomization units, the schools. The most important predictors of individual dropout were age and baseline caries experience, whereas sex was not associated with dropout. CONCLUSIONS: The results show that a community intervention trial of chewing gums carried out among schoolchildren is subject to cluster effects. Dropout was not primarily related to the randomization units themselves, i.e. the schools, but rather to subclusters of classes within the schools. These findings should be considered when designing community intervention trials and practical preventive programs among schoolchildren.
A tertiary-level academic hospital in Kaunas, Lithuania, adopted a continuous quality improvement (CQI) management paradigm from June 1996 through July 1997 in response to new political, economic, and social environments. This article presents an overview of the hospital's strategy, initial steps, and main accomplishments, as well as mitigating factors that arose in its quest to manage its own resources. Because historical influences are key to understanding the Lithuanian healthcare system, this discussion includes pre- and post-independence dynamics that caused a multidisciplinary hospital management team to choose a CQI approach that targets organizational and professional structures for change. In addition, it identifies environmental factors, internal and external to the hospital organization, that influence the continued development and sustainability of these healthcare management reform efforts.
STUDY OBJECTIVES: To examine whether psychosocial factors at work are related to self rated health in post-communist countries. DESIGN AND SETTINGS: Random samples of men and women in five communities in four countries were sent a postal questionnaire (Poland, Czech Republic and Lithuania) or were invited to an interview (Hungary). Working subjects (n=3941) reported their self rated health in the past 12 months (5 point scale), their socioeconomic circumstances, perceived control over life, and the following aspects of the psychosocial work environment: job control, job demand, job variety, social support, and effort and reward at work (to calculate a ratio of effort/reward imbalance). As the results did not differ by country, pooled analyses were performed. Odds ratios of poor or very poor health ("poor health") were estimated for a 1 SD increase in the scores of work related factors. MAIN RESULTS: The overall prevalence of poor health was 6% in men and 7% in women. After controlling for age, sex and community, all work related factors were associated with poor health (p<0.05). After further adjustment for perceived control, only two work related factors remained associated with poor health; the odds ratios (95% confidence intervals) for 1 SD increase in the effort/reward ratio (log transformed) and job variety were 1.51 (1.29, 1.78) and 0.82 (0.73, 1.00), respectively. Further adjustment for all work related factors did not change these estimates. There were no interactions between individual work related factors, but the effects of job control and social support at work differed by marital status, and the odds ratio of job demand increased with increasing education. CONCLUSIONS: The continuous measure of effort/reward imbalance at work was a powerful determinant of self rated health in these post-communist populations. Although the cross sectional design does not allow firm conclusions as to causality, this study suggests that the effect of the psychosocial work environment is not confined to Western populations.
OBJECTIVES: In Lithuania, there is little awareness of the notion that chronic symptoms may result from rear end collisions via the so-called whiplash injury. After most such collisions no contact with the health service is established. An opportunity therefore exists to study post-traumatic pain without the confounding factors present in western societies. METHODS: In a prospective, controlled inception cohort study, 210 victims of a rear end collision were consecutively identified from the daily records of the Kaunas traffic police. Neck pain and headache were evaluated by mailed questionnaires shortly after the accident, after 2 months, and after 1 year. As controls, 210 sex and age matched subjects were randomly taken from the population register of the same geographical area and evaluated for the same symptoms immediately after their identification and after 1 year. RESULTS: Initial pain was reported by 47% of accident victims; 10% had neck pain alone, 18% had neck pain together with headache, and 19% had headache alone. The median duration of the initial neck pain was 3 days and maximal duration 17 days. The median duration of headache was 4.5 hours and the maximum duration was 20 days. After 1 year, there were no significant differences between the accident victims and the control group concerning frequency and intensity of these symptoms. CONCLUSIONS: In a country were there is no preconceived notion of chronic pain arising from rear end collisions, and thus no fear of long term disability, and usually no involvement of the therapeutic community, insurance companies, or litigation, symptoms after an acute whiplash injury are self limiting, brief, and do not seem to evolve to the so-called late whiplash syndrome.
AIMS: To investigate the risk of a first time myocardial infarction (MI) among different occupational categories in 25-64 year old men in Kaunas, Lithuania, a country in a transition market economy. METHODS: Case-control study among men aged 25-64 who were residents in Kaunas between 1997 and 2000. First time, non-fatal MI cases (n = 448) were identified from the MI hospital register (International Classification of Diseases, 10th revision, code I21). Controls (n = 1777) were selected and matched on age, gender, and city district of residence. Information was obtained on occupation, smoking, hypertension, psychosocial, and behavioural factors. The International Standard Classification of Occupations (ISCO) was used to code for occupational categories. The relation between MI and occupational categories was evaluated by logistic regression analysis, adjusting for a number of selected risk factors. RESULTS: Legislators, senior officials, and managers (1st ISCO category) had a twofold increased risk for MI compared to craft and related trades workers (7th ISCO category) after adjustment for age, district, smoking, hypertension, obesity, stress, education, and employment duration. An increased risk for professionals (2nd ISCO category) and plant and machine operators and assemblers (8th ISCO category) was also observed. Employment duration in the last occupation for 20 years and more almost doubled the risk of MI in the whole population. We also found an increased risk for other traditional IHD risk factors such as smoking and arterial hypertension. CONCLUSIONS: Differences in first time MI risk among occupational categories were found. Legislators, senior officials, and managers (1st ISCO category), professionals (2nd ISCO category), and plant and machine operators and assemblers (8th ISCO category) were at an increased risk. Differences in psychosocial factors in transition market economy countries may contribute to observed results.
A genealogical study was performed in Lithuanian phenylketonuria (PKU) families with the aim of tracing the origins of the R408W/haplotype 2/VNTR3 allele. The relative frequency of six phenylalanine hydroxylase (PAH) mutations (R408W, R158Q, R261Q, G272X, IVS10nt-11g --> a, and IVS12nt1g --> a) common in Eastern European populations and their association with variable number of tandem repeat (VNTR) and short tandem repeat (STR) sites in the PAH gene were examined in 130 PKU Lithuanian chromosomes, including 95 of Baltic, 28 of Slavonic and 7 of unknown origin. R408W was found to be the most frequent (70%) mutation in both Balts or Slavonians with a uniform frequency distribution. No statistically significant differences in the frequency distribution of the other mutations analysed were found. In Balts and Slavonians, the R408W mutation is strongly associated with the three-copy VNTR and the 240-bp STR allele. The frequency of this association is 68% in both ethnic groups. The genealogical data provided in this paper indicate that the most common R408W/VNTR3/STR240 allele arose in ancient times possibly among pre-Indo-Europeans and suggest that the high frequency of the R408W mutation and associated minihaplotype in Balts of Lithuania is due to a founder effect.
BACKGROUND AND PURPOSE: Spontaneous intracerebral hemorrhage is a major cause of death and disability, yet there is no convincing evidence of the benefit of any medical treatment and the role of surgery remains controversial. The international randomized Surgical Trial in Intracerebral Hemorrhage (STICH) provided an opportunity to assess the role of surgery within the centers taking part. METHODS: Screening logs were completed to record details of all patients assessed by the department, whether they were included in the trial, the reasons if they were not included, and whether they underwent surgery. RESULTS: Logs were returned by 42 centers and cover 704 months. They include details on 1578 patients with characteristics comparable to STICH inclusion criteria. Neurosurgeons were more likely to express clinical certainty about treatment for older patients, patients with a higher Glasgow Coma Score scale, and patients in whom the hematoma was located on the right or in the basal ganglia or thalamus. Patients for whom the neurosurgeon was certain about treatment were more likely to have the hematoma removed if they were younger (62 versus 68 years of age), had a lower Glasgow Coma Scale score (10 versus 13), and had a lobar hematoma (49% versus 40%). The operation rate varied between 74% in Lithuania and 2% in Hungary. CONCLUSIONS: The difference in operation rates could not be explained by differences in patient characteristics alone. This finding demonstrates the need for further evidence to ensure that treatment for intracerebral hemorrhage is not governed by local custom.
BACKGROUND AND PURPOSE: Although in eastern Europe, mortality from stroke at present is the highest in the world, no previous prospective study of the risk factors for stroke has been reported from this part of the world. The aim of our study, therefore, was to evaluate the relations between blood pressure, serum total cholesterol, glucose intolerance, body mass index, and cigarette smoking and the risk of death from stroke in middle-aged men in Kaunas, Lithuania. METHODS: We conducted a prospective study with an average follow-up of 17.5 years of 2295 men who had participated in risk factor surveys within the framework of the world Health Organization Kaunas-Rotterdam Intervention Study from 1972 to 1974. Risk factors included in the current analyses were smoking, blood pressure, serum total cholesterol, glucose intolerance, diabetes, and body mass index. Age-and risk factor adjusted relative risks (RR) for death of stroke were determined by use of the Cox proportional hazards model. RESULTS: The strongest risk factors for death from stroke in middle-age men were systolic blood pressure (RR=1.02; P=.0001), diabetes (RR=4.17; P=.02), and smoking (RR=2.01; P=.004). Serum cholesterol, impaired glucose tolerance, and body mass index were not related to the risk of death from stroke. Twenty-five percent and 19% of stroke deaths were attributed to hypertension and smoking, respectively. CONCLUSIONS: Prevention and effective control of hypertension, smoking, and diabetes are the key elements in primary prevention of stroke in eastern Europe, where stroke mortality remains high.
PURPOSE: To assess the prevalence of age-related maculopathy (ARM) in a middle-aged urban population and the relationship between ARM and the main risk factors of cardiovascular disease (CVD). METHODS: The survey according to the WHO MONICA study protocol was carried out in Kaunas city, Lithuania, from 2001 to 2002. A total of 1403 persons aged 35 to 64 years were screened (626 men and 777 women: response rate 62.4%). Ophthalmologic investigation was performed for 1337 respondents (594 men and 743 women). Analysis of the relationship between ARM and risk factors of CVD was performed in case-control subdivision matching for sex, age, and education level. RESULTS: Early ARM was diagnosed in 7.4% of men and 5.4% of women. Rate of current smoking in case and control groups did not differ in men but in case group of women it was greater than in control group. Mean systolic and diastolic blood pressure and body mass index (BMI) in male case group and mean fasting blood glucose concentration in female case group were higher than in corresponding control groups. Frequency of diastolic hypertension (diastolic blood pressure > or = 90 mmHg) and obesity (BMI > or = 30 kg/m2) in male case group was higher than in control group. ARM was not associated with cholesterol and triglyceride levels in men and women. CONCLUSIONS: Early ARM in middle-aged Lithuanian urban population was associated with current smoking in women but not in men; it was associated with diastolic blood pressure and BMI in men and with fasting glucose level in women.
BACKGROUND: Suicidal behaviour is increasingly becoming a phenomenon associated with young people and an important public health issue in Lithuania. However, there are very few studies evaluating impact of young peoples' attitudes towards suicide to their suicidal behaviour. A better understanding of the relations among the variables associated with suicidal ideation and threats in the normal population of adolescents may eventually result in a better understanding of the more serious forms of adolescent suicidal behaviour. The aim of the present study was to evaluate prevalence of suicidal tendencies among Lithuanian schoolchildren and to estimate its association with an attitude towards suicide in 1994-2002. METHODS: Three country representative samples of schoolchildren, aged 11, 13 and 15, were surveyed in 1994 (n = 5,428), 1998 (n = 4,513), and 2002 (n = 5,645) anonymously in conformity with the methodology of the World Health Organization Cross--National study on Health Behaviour in School-aged Children (HBSC). RESULTS: About one third of respondents reported about suicidal ideation, plans or attempts to commit suicide. In the study period of eight years, the percentage of adolescents who reported sometime suicidal ideation decreased but the percentage of adolescents who declared serious suicidal behaviour remained on the same high level (8.1%, 9.8% and 8.4% correspondingly in 1994, 1998 and 2002). Moreover, the number of suicidal attempts changed from 1.0% in 1994 to 1.8% in the year 1998 and to 1,7% in the year 2002. The schoolchildren's attitude towards suicide became more agreeable: 36.6%, 41.9% and 62.5% of respondents, correspondingly in 1994, 1998 and 2002, answered that they agree with a person's freedom to make a choice between life and suicide. A multiple logistic regression analysis with low level of suicidality and high level of suicidality versus non suicidal behaviour as dependent variables for gender, age, year of the survey and attitude towards freedom to choose suicide as independent variables approved a significant association between studied covariates over the entire study period. CONCLUSION: Suicidal tendencies are quite frequent among Lithuanian adolescents. An increasing number of schoolchildren are expressing an agreeable attitude towards suicide. The approving attitude towards suicide among adolescents correlates with suicidal ideation and behaviour.
BACKGROUND: Recent reports have shown that air pollution may increase the risk of adverse birth outcomes. We have evaluated the relationship between ambient air pollution and the occurrence of low birth weight and preterm delivery using routinely collected data in Lithuania. METHODS: This epidemiological study comprised all singleton newborns (N = 3,988), born to women in 1998, who resided in the City of Kaunas. Birth data and information on maternal characteristics were obtained from the Lithuanian National Birth Register. To estimate residential exposure levels, we used measurements of ambient nitrogen dioxide (NO2) and formaldehyde, which were collected at 12 monitoring posts. Multivariate logistic regression was used to estimate the effect that each pollutant would have on low birth weight (LBW) and premature birth while controlling for potential confounders. RESULTS: Adjusted odds ratios (OR) for LBW increased with increasing formaldehyde exposure (OR2nd tertile = 1.86, 95% CI 1.10-3.16; OR3rd tertile = 1.84, 95% CI 1.12-3.03). Adjusted ORs of preterm birth for the medium and high NO2 tertile exposures were OR = 1.14 (95% CI 0.77-1.68) and OR = 1.68 (95% CI 1.15-2.46), respectively. The risk of preterm birth increased by 25% (adjusted OR = 1.25, 95% CI 1.07-1.46) per 10 microg/m3 increase in NO2 concentrations. An analysis by trimester showed that pregnancy outcomes were associated with first-trimester exposure to air pollutants. However, there were no significant relationships in other pregnancy periods between preterm birth and exposure to formaldehyde or between LBW and NO2 exposure. CONCLUSION: Our findings suggest that in the City of Kaunas there might be a relationship between maternal exposure to ambient formaldehyde and the risk of LBW, as well as between NO2 exposure and the risk of preterm birth.
Women prostituting in Vilnius City, Lithuania, were studied with regard to their socioeconomic background, drug and alcohol abuse, conditions for prostituting and for the carrier rate of sexually transmitted infectious agents. The 73 women studied represented a group of low-socioeconomic prostitutes with a great age span, i.e. 14-52 years. Forty-five per cent had one or more children. Roughly one-third were part-time prostitutes. Some had been trafficking for more than one decade. Some started trafficking at the age of 13, while the other extreme was a woman who began to prostitute at 51 years of age. This group of Vilnius street walkers had few customers per day. Eighteen were intravenous drug users and almost all abused alcohol. All, but one, had one or more sexually transmitted infections (STIs). Syphilis was diagnosed in 8 (13%) and another 10 (16%) had a serological scar of such an infection. HIV infections were not diagnosed. Condoms were not consistently used during their social contacts.
In 2003, a health IT programme for clinical decision support started in Lithuania. An initial goal was to create databases for ophthalmology images and to develop processing algorithms to extract diagnostically valuable information from images. We have investigated how vectors, consisting of the parameters derived from fundus images, are distributed and whether they form specific groups. When analysing the multidimensional patient data vectors, comprising all the 27 image parameters, it was impossible to separate the healthy eyes from the diseased ones. However, it was possible to simplify the system by eliminating redundant parameters and introducing new ones that represent a subset of parameters from the initial group. Thus it may prove possible to identify glaucoma using this system of parameters.
We analyzed the ratio of deaths from stroke and ischemic heart disease in Lithuania over a 72-month period (1990-1995) in relation to fluctuations in five physical environmental parameters. Results indicated a highly significant adverse correlation of the stroke/ischemic heart disease death ratio with both solar activity (r = -0.64, p = 0.0001), stronger for women than for men, and the planetary geomagnetic activity index (r = -0.33, p = 0.005). Proton flux > 60 MeV correlated significantly with the death ratio only for the 65-74-year age group (r = -0.36, p = 0.03) (36-month study). The last finding may be a result of different environmental influences on the pathogenesis of ischemic heart disease and cerebral vascular accidents at different ages. We conclude that the monthly ratio of deaths from stroke/ischemic heart disease is related to environmental physical activity.
The article elaborates on the role of international environmental regimes and multilateral environmental agreements in the process of development of environmental policy in the 3 Baltic countries; Estonia, Latvia, and Lithuania. Comparison of emission trends and changes in the state of the environment with reference to international environmental regimes allow one to conclude that there is no clear link between the official accession to environmental conventions and changes in environmental fields. The Baltic countries first joined international environmental regimes dealing with global or regional environmental security, while acceptance of the agreements and accession to regimes seen as more important from the point of view of solving their own environmental problems, took place later. Therefore, it can be concluded that the Baltic countries have seen the international legal instruments in their environmental policies as preventive, rather than curative instruments. Active participation in multilateral environmental agreements (MEAs) has, on the other hand, substantially contributed to the readiness of the Baltic countries to take the next step in their environmental policy--taking over the environmental policies (Acquis Communautaire) of the European Union.
The Raven Colored Progressive Matrices was administered to a sample of 259 children in Lithuania and re-administered 2 years later. The test-retest reliability was .499.