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Hepatitis B in parts of former USSR.

Hepatitis B is more frequent in many countries in eastern Europe than in the western part. In Poland the incidence is as high as 34 notified cases per 100,000 inhabitants. In the Baltic states the incidence is between 10 and 20, and in Russia 23 cases per 100,000 inhabitants. In the Baltic states the incidence has declined since 1986. This reduction has been most prominent in Lithuania, with 69%, followed by Latvia with 43% and Estonia with 23%. The infection is very often (> 50%) spread by non-sterile medical instruments.

Baltic States↗

Are there unmet family planning needs in Europe?

CONTEXT: The measurement of unmet need for family planning--the discrepancy between individuals' sexual and contraceptive behavior and their stated fertility preferences--has generally focused on developing countries. There has so far been little effort to measure how low unmet family planning needs can go in more developed countries, where contraceptive practice is supposedly (nearly) perfect. METHODS: Data were taken from Fertility and Family Surveys (FFS) conducted in recent years in selected member states of the United Nations Economic Commission for Europe, and minimum and maximum estimates of unmet need were calculated for 10 countries with the requisite data. RESULTS: The proportion of individuals with an unmet need for family planning (i.e., who have a current unwanted pregnancy or who are fecund, are sexually active, want no more births but are not using contraceptives) is as low as 3% in two European countries and below 10% in most. However, levels of unmet need in countries with economies in transition (13% in Latvia and Lithuania and 23% in Bulgaria) surpass some of the lowest levels observed for developing countries. Considerable within-country variations are seen. For instance, unmet need is more prominent among men than among women in seven of the nine countries for which there are data. Moreover, unmet need increases with family size and with age, suggesting an unmet need for limiting rather than for spacing births. In all of the countries except Hungary, unmet need is higher among those in marital unions than among those in less formal relationships. Level of education is another important dimension of unmet need, with less-educated respondents having the highest level of unmet need in nine of the 10 countries. Multivariate analyses confirm most of these results. Moreover, there is a clear association between unmet need and abortion ratios: Where levels of unmet need are high, the number of abortions per 100 live births is also relatively high. CONCLUSIONS: Data on unmet need, supplemented with information on induced abortion and related issues, could provide countries in Europe with useful inputs for formulating and implementing responsive reproductive health policies and programs.

Contraception Behavior↗

Risk and protective factors in children adopted from the former Soviet Union.

INTRODUCTION: The former Soviet Union (including the present independent republics of Russia, Ukraine, Latvia, Belarus, Lithuania, and Georgia) is the leading source of children adopted from overseas by persons in the United States (US Department of State, 1998). This study sought to (a) characterize the current social, academic, and conduct competencies of 6- to 9-year-old children adopted from the former Soviet Union who have resided in the United States for at least 2 years and (b) evaluate both risks and protective influences of adoptive families and their relationships to competence via a structural equation model. METHOD: Telephone interviews and a postal survey of children were drawn from a US community sample of 105 children. Measures included (a) Child Behavior Checklist, (b) Teacher Report Form, (c) Vineland Adaptive Behavior Scales, (c) Family Environment Scale, and (d) demographic information. RESULTS: Many children had experienced abuse, abandonment, or neglect between birth and entry to the institution. Their mean birth weight was 2637 g, and alcohol abuse by the birth mother was common (41%). Although the children scored below average in competence, adoptive family environments were positive and served as buffers between the risks experienced by the children and the subsequent development of competence within the adoptive family. CONCLUSION: Children's abilities ranged from severely challenged to developmentally normal. The high rate of fetal alcohol exposure in the children may portend future challenges for families.

Adaptation, Psychological↗

[In vivo and vitro effects of interferon-alpha 2b on functional activity of T-lymphocytes from patients with rheumatoid arthritis].

AIM: To investigate the effect of recombinant alpha 2b-interferon (r alpha 2b-IFN) on functional capacity of peripheral blood (PB) T cells in rheumatoid arthritis (RA) patients and the relationship between functional characteristics of T lymphocytes and the disease activity. MATERIALS AND METHODS: PB mononuclear cells (PBMC) were separated by Ficoll-Verografine++ gradient centrifugation from 24 healthy donors (HD) and 75 RA patients 19 of which were treated with r alpha 2b-IFN (realdiron, Biofa, Lithuania) in the dosage 1 million IU i.m. each other day for 20 days, 10 injections a course. Cell surface markers (CD3, CD4, CD8) and adhesion molecules (CD18, CD54, CD2) were analyzed using specific monoclonal antibodies (MoAbs) and flow cytometry on the PBMC, freshly isolated and treated for 72 hours with medium alone, PHA, r alpha 2b-IFN and their combination. The proliferative response of PBMC to MoAbs for CD3, PHA and r alpha 2b-IFN were assessed by 3H-thymidine incorporation. The percentage of spontaneous and inducing apoptosis was quantified by flow cytometry using propidium iodide staining. RESULTS: The expression of CD18 was lower on RA PB lymphocytes compared to HD PB lymphocytes (p < 0.05). After stimulation of PBMC in both RA patients and HD with PHA, percentages of CD2+, CD3+, CD4+, CD18+ cells significantly diminished (p < 0.05), whereas the percentages of CD54+ and CD18+ (p < 0.05) cells increased. We have found three types of RA PB lymphocytes response to complex factors in vitro: 1) the presence of the proliferative response to T-mitogens but not to r alpha 2b-IFN (56% of the patients); 2) the presence of the increased proliferative response to T-mitogens and r alpha 2b-IFN (17% of the patients); 3) the absence of the proliferative response to T-mitogens and r alpha 2b-IFN (27% of the patients). PBMC of HD demonstrate only the first type of the response. R2 alpha b-IFN demonstrated own mitogenic effect and increased mitogen-induced proliferation in PBMC cultures with a high proliferative response to T-mitogens. The levels of spontaneous and inducing apoptosis were increased in RA PB lymphocytes compared to HD. After stimulation with PHA, RA PB lymphocytes preferentially underwent apoptosis whereas cells of HD proliferated. High disease activity correlated positively with an increase of a proliferative response to mitogens and apoptosis and a decrease in the percentage of lymphocytes, expressed adhesion molecules. The treatment with r alpha 2b-IFN induces changes in T-cell response to mitogens similarly to those after incubation with r alpha 2b-IFN in vitro before treatment. CONCLUSION: Functional capacity of RA PB lymphocytes relates to the disease activity. Inhibitory or stimulatory effects of r alpha 2b-IFN depend on functional activity of RA lymphocytes. Using the test with alpha 2b-IFN incubation, we may predict changes of apoptosis and proliferation levels caused by different agents in RA lymphocytes after treatment with r alpha 2b-IFN.

Angiogenesis Inhibitors↗

Evaluation of prenatal diagnosis of cleft lip with or without cleft palate and cleft palate by ultrasound: experience from 20 European registries. EUROSCAN study group.

Ultrasound scans in the mid-trimester of pregnancy are now a routine part of antenatal care in most European countries. Using data from registries of congenital anomalies a study was undertaken in Europe. The objective of the study was to evaluate prenatal detection of cleft lip with or without cleft palate (CL(P)) and cleft palate (CP). All CL(P) and CPs suspected prenatally and identified at birth in the period 1996-98 were registered from 20 Congenital Malformation Registers from the following European countries: Austria, Croatia, Denmark, France, Germany, Italy, Lithuania, Spain, Switzerland, The Netherlands, UK, Ukraine. These registries followed the same methodology. A total of 709,027 births were covered; 7758 cases with congenital malformations were registered. Included in the study were 751 cases reported with facial clefts: 553 CL(P) and 198 CP. The prenatal diagnosis by transabdominal ultrasound of CL(P) was made in 65/366 cases with an isolated malformation, in 32/62 cases with chromosomal anomaly, in 30/89 cases with multiple malformations and in 21/36 syndromic cases. The prenatal diagnosis of CP was made in 13/198 cases. One hundred pregnancies were terminated (13%); in 97 of these the cleft was associated with other malformations.

Cleft Lip↗

[Nicotine addiction].

According to the WHO reports from 1997, Bosnia and Herzegovina takes a disgraceful first place in smoking prevalence in Europe. 53% of smokers over 15, then 22% of women, 67% of men are percentages that are not achieved by countries at a much lower development level than B&H. The mortality rate of men (aged 35-64) as a result of tobacco varies from 11% to 45% from country to country. In 11 European countries it is > or = 40% and they are all in the eastern part of the region: Belarus, the Czech Republic, Hungary, Kazakhstan, Lithuania, Poland, Russia, Slovenia, Ukraine, B&H. Tobacco addiction, like other drug addictions, is basically a neurobiological mediated brain disease. In the same way, the discontinuation of drug taking, in this case nicotine, is a very important addiction component and one of its clearest manifestations. So, the symptoms of iving up smoking are in fact the symptoms mediated by noradrenalien (excitement, tension, long-lasting desire, distraction, insomnia, increase in appetite, putting on weight, etc). According to the Diagnostic and Statistical Manual for Mental Disorders-4th Edition (DSM-IV), both toxicomanic nicotine addiction and the discontinuation of smoking are classified as diseases. The smokers who give up smoking before they are 50 decrease their mortality risk by 50% over the next 15 years compared to those who continue smoking. This risk decrease is related to the incidence decrease and mortality rate from specific, smoking-related diseases, including: coronary heart disease, strokes, peripheral vascular diseases, COPD and lung cancer. The assistance to addict to give up of smoking is duty of professionals.

Adult↗

Prevalence of cryoglobulinemia in patients with chronic HCV infection.

BACKGROUND: The purpose of our research was to determine the prevalence of cryoglobulins in patients with chronic hepatitis C (CHC) at different levels of activity and stage of fibrosis and to identify their association with the extrahepatic clinical manifestations. MATERIAL/METHODS: 87 patients with CHC were investigated for the presence of cryoglobulins. Cryocrit was measured by the Weiner method. AntiHCV, HCV RNR, conventional biochemical tests and liver biopsy were also performed. RESULTS: Cryoglobulins were found in a total of 44 patients: 16 from Group I, 11 from Group II, and 17 from Group III. A low level of cryoglobulinemia (Cg) (cryocritL2%) was detected in 16 patients: 9 from Group I, 3 from Group II, and 4 from Group III. Moreover, a high Cg (cryocrit >5-10%) or very high Cg (cryocrit >10%) was found in a total of 13 patients: 1 patient from Group I, 3 from Group II, and 9 from Group III. Cryo positivity was found in 5 patients with F 1-2, in 13 with F 2-3, in 4 with F 3-4, and in 17 with F 4. CONCLUSIONS: Our findings confirmed the high prevalence of Cg in CHC patients in Lithuania, a clear association between Cg and the stage of fibrosis, the higher prevalence of Cg in cirrhotic patients, and the occurrence of several typical extrahepatic manifestations. The impact of Cg on the course of chronic hepatitis C is not clearly understood; therefore, further studies are needed to clarify this issue.

Adult↗

[Vilnius Medical Association: the first half-century (1805-1850)].

Vilnius Medical Association, oldest scientific medical association in Poland and in the Russian Empire, was founded for the purposes of self-development in 1805 on the initiative of an Austrian professor of pathology and detailed therapy, Józef Frank (1771-1842). From its beginnings, the association acted for the good of society and science, independently of political conditions and with varying intensity. Apart from doctors, it also included pharmacists who contributed towards raising the standard of pharmacy in Lithuania. The first half-century of its existence constitutes the most fruitful period of activity as it was supported by professors of the then Medical Department of Vilnius University. At that time the Association established its regulations, founded the Library, and published "Pamietnik Wileńskiego Towarzystwa Lekarskiego" (Journal of Vilnius Medical Association, 1818 and 1821), "Pamietnik Farmaceutyczny" (Pharmaceutical Journal, 1820 and 1821), "Dziennik Medycyny Chirurgii i Farmacji" (Journal of Medicine, Surgery and Pharmacy, 1820, 1823, and 1830), as well as "Collectanea Medico Chirurgica", 1838. It also began gathering and analysing data for medical statistics, as well as developing Polish medical and chemical nomenclature. The Association re-organised shipments of medicines from pharmacies. It endeavoured to raise the standard of medical knowledge in the Vilnius area, combated epidemics of plague, cholera, scarlet fever, smallpox, typhus, diphteria, dysentery and monitored occurrences of plica. It also established the first Institute of Vaccination against Smallpox in Vilnius (1809); carried out scientific research on health resorts at Druskienniki, Birsztany and Stokliszki; promoted hygiene and examined the health of the inhabitants of Vilnius and the surrounding area as well as endorsed authority decisions related to the location of temporary military hospitals. At its meetings, members of the Association discussed their own medical cases as well as methods of treatment, presented the most recent reports in the medical literature, combated obsolete theories and scientific systems and established cooperation with other scientific associations in the country as well as abroad. World famous scientists were also members of the Vilnius Medical Association.

History, 19th Century↗

[Allergic seasonal rhinoconjunctivitis without indigenous pollen sensitization: the example of the Arizona cypress].

A 37-year old man from Lithuania presented with the typical symptoms of allergic rhinoconjunctivitis that appeared in spring this and the year preceding presentation. Skin prick tests for aeroallergens indigenous in Switzerland were all negative. A detailed history revealed that the patient was working in a building of a United Nation's agency surrounded by a park with numerous cypresses of Arizona trees. A skin prick test for pollens from Cupressus arizona was strongly positive, supporting the diagnosis of allergic rhinoconjunctivitis to pollens from this tree. Allergy to pollens from C. arizona is a widely prevalent as winter pollinosis in subtropical and Mediterranean areas but is exceptional in the continental and alpine climates of Switzerland. Five cases of C. arizona pollinosis have been diagnosed in the last 3 years in Geneva. It is notoriously difficult to diagnose cypressus pollen allergy, mainly because of the poor quality of in vivo and in vitro available tests. Horticulture with non-indigenous plants is responsible for pollinosis from C. arizona in Switzerland. The specialists in countries in which pollinosis from C. arizona is not endemic, need to be aware of arboriculture with non-indigenous plants, as well as the possibility of allergy to C. arizona.

Adult↗

The required number of physicians: is it an optimal figure?

Apart from the developing countries in which the number of physicians is extremely low, the number of physicians in the different countries shows a wide range even if it is comparing with the GDP or even with the number of nurses. According WHO data there are more than 500 physicians/100,000 inhabitants in Cuba and in Italy; more than 400 in Belarus and Norway, or in Spain and Georgia; more than 300 in 22 countries among them Belgium, France, Germany and Greece, Sweden, Switzerland, or Bulgaria, Czech, Hungary, Slovakia, Lithuania, etc. The number of doctors is below 300/100,000 inhabitants for example in such rich countries as the Netherlands, and the USA, and below 200 in the United Kingdom or in Japan. There is no correlation between the GDP and the number of doctors, as well as between the average life expectancy (or GBD, DALY, DALE) and the number of doctors. (On the other hand there is good correlation between GDP and life expectancy.) There is no correlation between GP-s and specialists, but it may be a weak correlation between the number of hospital beds and the number of doctors. It is difficult to find an optimal doctor/nurse ratio among the different countries; nevertheless the definition of "nurses" has a different meaning in the different countries. The burden of diseases, or the "patients" load" is also not an objective reference point, because the more the doctors, the more the patients. In the different countries there are different norms of the physicians' performances mainly decided by the health insurance funds. The different reimbursement systems, as the "per capita" at the GP-s, or the DRG at the hospital care, or the point-based remuneration at the specialist care are the real rate limiting factors for the number of physicians, which are not necessarily adequate to the professional requirements.

Developing Countries↗

Bacterial and fungal aerosols in indoor environment in Central and Eastern European countries.

Studies of indoor bioaerosols conducted in Central and Eastern European countries, as a result of the scarcity of funding, mostly do not attain the level presented by similar studies in Northern America and Western Europe. For socio-economic reasons, most of the intense studies on indoor bioaerosols in Central and Eastern European countries were carried out in industrial facilities and have contributed significantly to occupational health science. In contrast, until recently, insufficient of studies have been conducted on bioaerosols of residential and communal premises (dwellings, offices, schools, etc.) and no network for monitoring the microbiological quality of air in such premises exists. In Poland, in the mid-1990s complex bioaerosol investigations were carried out by the Bioaerosol Group at the Institute of Occupational Medicine and Environmental Health in Sosnowiec. The concentrations of airborne bacteria and fungi in dwellings without mold problems were between 88-4297 cfu/m(3) and 0-1997 cfu/m(3), while in moldy homes they were 178-4751 cfu/m(3) and 49-16,968 cfu/m(3), respectively. As many as 167 microbial species were isolated from the air of examined dwellings. Most frequently occurred Gram-positive cocci (Micrococcus/ Kocuria spp., Staphylococcus spp.), endospore-forming bacilli (Bacillus spp.), Gram-negative bacteria (Pseudomonadaceae, Aeromonas spp.), filamentous fungi (Penicillium spp., Aspergillus spp.), and yeasts. Notable studies of indoor bioaerosols have also been performed in the other Central and Eastern European countries: Lithuania, Latvia, Estonia, Russian Federation, Ukraine, Czech Republic, Slovakia, Bulgaria and Hungary, are reviewed in this article. The lack of reference limit values for bioaerosols seriously hinders interpretation of results obtained in various countries. The following residential limit values (RLV) for dwellings and communal premises are proposed for the concentration of airborne bacteria, fungi and bacterial endotoxin: 5 x 10(3) cfu/m(3), 5 x 10(3) cfu/m(3) and 5 ng/m(3) (50 EU), respectively. The proposed values of occupational exposure limit (OEL) for industrial settings contaminated by organic dust are 100 x (3) cfu/m(3), 50 x (3) cfu/m(3) and 200 ng/m(3) (2000 EU), respectively. It is also proposed that the presence in indoor air of microorganisms from risk groups 3 and 4 of European Community Directive 2000/54/EC (e.g., Mycobacterium tuberculosis, Bacillus anthracis, Coxiella burnetii), independently of the concentration, should always be inadmissible and result in preventive actions.

Aerosols↗

[The treatment of "Rybenka": therapies and medical operations on Michał Kazimierz Radziwiłł, 1702-1762].

The present paper discusses and analyses treatment methods and medical care given to the Voivod of Vilnius, the Grand Hetman of Lithuania M. K. Radziwiłł throughout all his life. This analysis is not representative for the general medicine of the 18th century. M. K. Radziwiłł was one of Poland's richest men of the time and only few aristocrats rich like him could afford similar therapies. The paper is based on unpublished archival sources, such as diaries and correspondence. Radziwiłł was subject to 65 breedings (blood was taken from his leg) which were usually performed in springtime; 30 leech applications (to his haemorrhoids); and he was cupped 13 times. He ws also treated for his bad jaw, broken arm, and received hydrotherapy (drinking water). All in all, the therapies, operations, and medicines preformed and prescribed to him make up a picture of medicine which, according to today's scientific criteria, did more harm than good to the patient. Nonetheless, this does not change the fact that medical care of the time also included treatments which are well evaluated by present-day medical science, such as, for example, recommending comfort and rest to the patients.

Family Characteristics↗

Escitalopram H Lundbeck.

Lundbeck and Forest have developed and launched escitalopram, the therapeutically active (S)-enantiomer of citalopram, as an improved follow-up compound for the potential treatment of depression. In December 2001, Lundbeck received Swedish approval for the treatment of depression and panic disorder [433058], and in January 2002, the product was approved in Switzerland for the treatment of depression [434736]. By May 2002 it had been approved in Belgium, Denmark, the UK, France, Iceland, Luxembourg, Norway and Austria, as a result of the European Mutual Recognition Procedure. Independently, regulatory authorities in Lithuania had also approved the drug for the treatment of depression. Launch in these countries will begin immediately after price and reimbursement negotiations are completed [450860]. By June 2002, it had been launched in Switzerland, Sweden and the UK [454488]. Based on the approvals in the EU, national applications are being submitted in several Central and Eastern European countries, where review and the first approvals were expected in the second half of 2002. At this time, the approval of escitalopram in Australia and Canada was expected in the second half of 2002 and the first half of 2003, respectively [450860]. It became evident in May 2002, that Portugal, Greece, Italy, Spain, Finland and Germany did not intend to approve escitalopram for marketing within the 90-day timeframe, and, at this time, Lundbeck, in accordance with the advice of the reference country, Sweden, chose to withdraw the registration applications from these six countries. At this time, the company still expected escitalopram to be approved in these countries [450860]. In the US, Forest submitted an NDA in March 2001 [402983] and in January 2002, Forest received an approvable letter from the FDA for escitalopram; at this time, US launch was expected in mid-2002 [437487], [444243]. By March 2002, Lundbeck had started to supply escitalopram to Forest [442326]. Lundbeck and Morchida entered a Japanese development and marketing agreement in May 2002, replacing a collaboration with Mitsui [453377].

Antidepressive Agents↗

[Infant mortality trends in countries of Central and Eastern Europe].

"After... World War II, infant mortality in countries of Central and Eastern Europe...started to diminish. This favourable trend lasted up to the beginning of the sixties. Later on the unfavourable evolution of infant mortality was connected with the failure in reduction of endogenous mortality, i.e. the mortality soon after the delivery. Nowadays [in some countries, such as the Czech Republic,]...the decrease continues and in [other] countries (Lithuania, Latvia, Estonia) the infant mortality rate has temporarily increased due to adoption of the international definition of live and still births, while in [the] majority of countries of the previous Soviet Union and former Yugoslavia...infant mortality...has increased." (SUMMARY IN ENG AND RUS)

Demography↗

Distribution and dynamics of rural population in Central Eastern Europe in the 20th century.

This is an analysis of rural population trends in Central Eastern Europe during the twentieth century. The region is defined as including "Estonia, Latvia, Lithuania, the Kaliningrad District, Belarus, Ukraine, Poland, Czechoslovakia, Hungary, Rumania, Moldavia, Bulgaria and Yugoslavia....For each of them the size of rural population and its density have been evaluated, and then, the dynamics of demographic evolution described. An important part of the analysis has been the comparison of rural population to total population. On the basis of this comparison, structural changes and demographic trends have been defined. Particular attention has been paid to the processes of depopulation as well as their range and intensity in rural areas of Central Eastern Europe."

Demography↗

[Early attention in Europe].

INTRODUCTION: Early attention is one of the tasks of maximum priority. It is the subject of investigation throughout Europe from the educational point of view. OBJECTIVE: We describe the principal characteristics and organization of Early Attention in 18 European countries: the 15 states which are members of the European Union, Norway, Iceland and Lithuania. MATERIAL AND METHODS: The information is based on the study done by the European Agency at the end of 1998 in 17 countries, updated in 2001 and extended to 21 countries. The data obtained from the countries recently included is currently being analyzed bit is not yet fully available. The previous European studies have been repeated and brought up to date by means of questionnaires. The findings have been completed by analysis of practical examples provided by professionals from different countries. RESULTS: We present general information regarding the situation of Early Attention in these 18 countries: its relationship with the educational services, its organization, composition, financing; the organization, function and qualification of the professionals belonging to the Early Attention teams; participation of the families. Conclusion. We show a series of critical factors: the importance of attention being very early, overall evaluation of the child s possibilities and effective cooperation of the child's relatives.

Child↗

[Anesthesia used in minimally invasive myocardial revascularization surgery].

As myocardial revascularisation operations without cardiopulmonary bypass are getting more popular, more facts are found about their surgical techniques. However, the questions considering their anesthesia, the protection of myocardium and other are not widely analyzed. The specific features of anesthesia in cardiosurgery, such as methods of ventilation, combination of induction and general anesthesia with epidural anesthesia, usage of cardiac protection and ischemic preconditioning, monitoring, heparin management, usage of drugs, postoperative pain management are given in this article. As anesthesiological and surgical techniques are getting better and the professional skills of surgeons and anesthesiologists are improving, given data should improve the perspectives of minimally invasive cardio surgery operations and anesthesia in Lithuania.

Aged↗

[Poisonings with psychotropic drug mixtures: analysis using the thin-layer chromatography method].

It is observed increase in number of remedy intoxications in Lithuania, especially important is intoxication with psychotropic drugs and their mixtures. The thin-layer chromatography (TLC) method was proposed for separation and identification of drugs in mixture aminazine: nitrazepam: barbamylum. The mixture of these drugs excreted from body fluids (blood and urine) was investigated by TLC. Most acceptable these mobile phases: 1. Diethyl ether: dioxane--40:60. Rf values for drugs: aminazine 0.23-0.25; barbamylum 0.85-0.9; nitrazepam 0.75-0.8. 2. Diethyl ether: NH3 (25%): benzenum--80:10:10. Rf values for drugs: aminazine 0.55-0.58; barbamylum 0.32-0.35; nitrazepam 0.17-0.2.

Amobarbital↗