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PubMed2003

Prevalence of dyslipidemias among Lithuanian rural population (CINDI program).

The aim of this study is to describe trends in serum total, low and high density lipoprotein cholesterol, triglycerides and nutrition habits in Lithuanian rural population between 1987 and 1999. The article presents the data of three screenings of random samples of the population aged 25-64 of five Lithuanian rural regions. Since 1987 the prevalence of hypercholesterolemia has decreased. The greatest decrease was observed in the proportion of persons with elevated level of low-density lipoprotein cholesterol. The prevalence of low level of high-density lipoprotein cholesterol decreased more significantly among women compared to men. The most remarkable changes in the prevalence of dyslipidemias were observed between 1993 and 1999. The increasing age was strongly correlated with higher prevalence of hypercholesterolemia in both genders. The prevalence of hypercholesterolemia was higher among men with higher education, overweight, hypertension and smokers than among those with low education, normal weight, normal level of blood pressure and nonsmokers. In women hypercholesterolemia was associated only with hypertension. The nutrition habits of Lithuanian rural population have changed, especially over the last five years. The consumption of animal fat has decreased and the usage of vegetable oil and margarine has increased. Women increased consumption of vegetables and fruits. The strengthening of favorable trends in nutrition habits in Lithuanian population should be one of the most important strategies in the implementation of cardiovascular disease prevention programs.

Adult↗
PubMed2003

Age-related maculopathy and consumption of fresh vegetables and fruits in urban elderly.

The purpose of this study was to investigate the rate of age-related maculopathy among elderly males and females in relation to frequency of consumption of fresh vegetables and fruit. During ophthalmological investigation of Kaunas city inhabitants aged 65-74 years (240 males and 206 females) age-related maculopathy (early and late) was determined for 22.1% of males and 20.4% of females. Frequency of usage of fresh (uncooked) vegetables and fruits in winter-spring and in summer-autumn seasons by investigated persons was determined, using food frequency questionnaire. In this work an association between age-related maculopathy and usage of vegetables and fruits has been investigated in 170 males and 181 females aged 65-74 years without diabetes who never smoked; age-related maculopathy was found for 18.8% of males and 17.7% of females. Obtained data have demonstrated an inverse association between consumption of vegetables during winter-spring season and age-related maculopathy: usage of vegetables two times a week or more versus usage less than two times a week decreases prevalence of age-related maculopathy 2.0 times among males (OR=0.42; 95% CI 0.18-1.0; p=0.05) and 2.2 times among females (OR=0.37; 95% CI 0.15-0.9; p=0.02). Data have demonstrated a tendency that increasing consumption of fresh vegetables and fruits during both seasons can reduce risk of age-related maculopathy among females. In conclusion, characteristic for Lithuanian urban elderly rare usage of fresh vegetables during winter-spring season can increase risk of age-related maculopathy independently from other risk factors.

Age Factors↗
PubMed2004

[Direct and indirect diabetes costs in the world].

Diabetes is becoming one of the major public health problems because a great proportion of the healthcare expenditure has been spent on the treatment of its associated morbidity and mortality. Diabetes is also a major cause of premature mortality, stroke, cardiovascular disease, peripheral vascular disease, congenital malformations as well as long- and short-term disability. In addition, persons with diabetic complications have a lower quality of life compared with persons without diabetes. The goal of this paper is to review the studies on the costs of diabetes, to identify the strengths and limitations of currently available diabetes cost studies, and to identify future research areas that will help us to better understand the economic burden of diabetes. The economic burden of diabetes mellitus is enormous in the world. Cost or illness estimates are often cited as an important element in the choices made regarding diabetes care and management. Studying these economic aspects presents several challenges, such as collecting the appropriate epidemiological and cost data, determining the diabetes attributable factors for premature morbidity and mortality, and determining methods to account for premature morality, disability, and reduced quality of life. The cost to care for diabetes puts a tremendous burden on both the patient and the payer. The direct cost of diabetes increased from 1.7 billion US dollars in 1969 to 44.4 billion US dollars in 1997. Several studies over the years have found that indirect costs related to diabetes are higher than direct. Indirect costs during 28 years increased 33 times, from 1.6 billion US dollars in 1969 to 54.1 billion US dollars in 1997. The expenses of one diabetic patient highly vary in different countries: from 13 US dollars in Bangladesh to 11,157 US dollars in USA per one year. Most of diabetes expenditure is used to pay for inpatient services (60-85%); the biggest part of it is incurred because of late diabetes complications (70%). Diabetes accounted to 3-12% of total healthcare expenditure in different countries. In this era of limited resources and escalating costs, it is critical to have an understanding of the economics of diabetes in order to develop and implement sound public health and prevention policies.

Adult↗
PubMed2004

[Clinical forms of new cases of tuberculosis at Kaunas Romainiai Tuberculosis Hospital in 1998-2001].

Totally 1427 patients with tuberculosis were investigated in Kaunas Romainiai Tuberculosis Hospital. All patients belonged to the first category (new cases positive for mycobacterium tuberculosis, or severe tuberculosis). Infiltrated and disseminated tuberculosis were the most frequent clinical forms. The frequency of infiltrated tuberculosis ranged from 57.36 to 68.8%, and disseminated tuberculosis ranged from 18.52 to 30.36%. The most frequent complications were bleeding from the lungs and chronic cor pulmonale. The resistance to isoniazid, rifampicin and streptomycin was investigated. Multi-drug resistant tuberculosis did not exceed 1%. We suggest that so few cases of multi-drug resistant tuberculosis are due to implementation of WHO treatment standards.

Adolescent↗
PubMed2004

[Trends in out-of-hospital mortality from ischemic heart disease in Kaunas middle-aged population during 1983-1998].

UNLABELLED: The aim of the study was to evaluate trends in out-of-hospital mortality from ischemic heart disease (IHD) in Kaunas population aged 25-64 years during 1983-1998, according to the ischemic heart disease register data. MATERIALS AND METHODS: The primary source of data was Kaunas population-based ischemic heart disease register. The main sources of information for registration of ischemic heart disease events were hospital discharge records, patient follow-up records of out-of-patient departments, death certificates, necropsy and medico-legal records. The data were collected according to the requirements of the WHO program MONICA. Only deaths from IHD that occurred out-of-hospital were analyzed in this study. The age-standardized rates were calculated by the direct method and the world standard population was used as the standard. Trends in rates were analyzed using the method of linear regression on logarithms of the age-standardized annual mortality rates. RESULTS: During 1983-1998, out-of-hospital IHD mortality was 137.9/100000 among Kaunas men aged 25-64 years meanwhile among women the corresponding rate was 7 times lower (20.2/100000). During 1983-1994, out-of-hospital mortality from IHD was increasing and during 1995 to 1998 was decreasing (by 19.8% per year; p=0.03) among men. Among women, out-of-hospital mortality rates were increasing during 1983-1990, were rather stable during 1991-1994, and tended to decrease by 27.5% per year (p=0.09) during 1995-1998. When analyzing trends in rates by 10-year age groups, statistically significant changes in out-of-hospital mortality from IHD were detected just among those aged 55-64 years. Among men, out-of-hospital mortality from IHD tended to increase during 1983-1994, and was decreasing statistically significantly (by 22.9% per year; p=0.007) during 1995-1998. Among women, the corresponding rates were increasing by 26.7% per year (p=0.03) during 1983-1986, and tended to decrease by 40.1% per year, (p=0.09) during 1995-1998. During 1983-1998, out-of-hospital deaths from IHD accounted on the average for 76.5% among all deaths from IHD among men and for 66.9% among women. During 1983-1998, the proportion of out-of-hospital deaths among all deaths from IHD remained without statistically significant changes among both men and women. CONCLUSION: During 1983-1994, out-of-hospital mortality rates of Kaunas middle-aged men increased and during 1995-1998--significantly decreased. Out-of-hospital mortality rates of Kaunas women increased during 1983-1990, but in 1995-1998--tended to decline. Out-of-hospital deaths from IHD accounted on the average for 76.5% of all deaths from IHD among men and for 66.9% of women deaths, and biggest part of these deaths were among younger persons.

Adult↗
PubMed2004

Familial variables as predictors of psychological maladjustment in Lithuanian children with phenylketonuria.

BACKGROUND: Children with phenylketonuria of early onset under continuous treatment are considered at higher risk for psychological maladjustment than children without other chronic diseases. The aim of the present study was to evaluate the psychological adjustment of Lithuanian children with treated phenylketonuria and analyze it in the context of the psychological adjustment of their parents. MATERIAL/METHODS: The parents of 37 early-treated children (age 4-14 years old) with phenylketonuria and of 37 matched controls were asked to fill out the Child Behavior Checklist and questionnaire on stress coping strategies. Parents of children with phenylketonuria answered a questionnaire on reactions to the child's disease and its impact on the family. RESULTS: Lithuanian children with treated phenylketonuria have significantly more emotional and behavioral problems than healthy controls. They are more withdrawn, anxious/depressed, have more social and attention problems. The higher rates of internalizing and total problems are related to parental maladjustment (feelings of guilt and anger) together with maladaptive (emotional) everyday stress coping strategies. These last two factors promote overindulging the child, which is also a predictor of psychological maladjustment in children with phenylketonuria. CONCLUSIONS: The already existing organic vulnerability may account for the greater susceptibility of children with phenylketonuria to psychological risk factors, as for example parental inability to cope adequately with everyday stress related to the demands of disease and its treatment.

Adolescent↗
PubMed2004

[Assessment of health care services quality by medical professionals and patients].

The article presents the data of medical professionals and patients' assessment of health care services quality in Jurbarkas hospital. All physicians and nurses, working full time, and patients, treated in the hospital within November-December 2002, were invited to participate in the survey. The response rate among the physicians was 79.5%; while among the nurses and the patients it was 64.5%, and 68.9% correspondingly. The patients and medical professionals' satisfaction was evaluated using an anonymous questionnaire, which was developed with the reference to R. J. Ferguson et al proposed method for health care service quality assessment. It was determined, that physicians and nurses assessed health care quality in the hospital similarly. The patients' assessment of overall health care services was higher compared with that of the medical professionals. The overall health service quality was rated 4.26 (0.6) points by the patients, 3.81 (0.5) points by physicians and 3.74 (0.8) points by nurses, p<0.05. The technical aspects of health care quality were assessed worse than the functional ones both by medical professionals and patients. The physicians and nurses rated their communication with the patients more critically than the patients. The differences between the medical professionals and patients' assessments concerning health care services quality demonstrate, that in order to achieve comprehensive information, it is necessary to organize a universal survey. The information assembled from different sources will allow collecting more objective and comprehensive data about the quality of health care services in hospital.

Data Interpretation, Statistical↗
PubMed2004

[Patient confidence in health care].

The aim of the study was to evaluate patient confidence in organization of health care and health care policy. The study material was gathered using self-administrated anonymous questionnaire in November-December, 2001. The patients were recruited from therapeutic departments of Kaunas 2nd hospital and Alytus S. Kudirka hospital. The data was analyzed using Microsoft Excel and SPSS program data package. Chi-square test was used to compare observed results with expected results. The hypothesis was statistically significant at the p<0.05. More patients in Alytus hospital (31%) than in Kaunas hospital (22%) predicated as being non-confident in health care policy. Statistical significant difference between patients of two hospitals was obtained comparing opinion about health care reform. Alytus S. Kudirka hospital patients were more optimistic about health care reform than patients in Kaunas hospital. Thirty percent of patients in Alytus hospital and 19% in Kaunas hospital were confident that reform has improved their treatment (p<0.05). More patients in Kaunas hospital (22%) than in Alytus hospital (9%) confirmed that health care reform aggravated their treatment. The majority of Alytus hospital patients (62%) and 40% of Kaunas hospital patients were satisfied with health care services. More than half respondents were not confident in health care system but they trusted physicians. Gender and education level had impact on patient confidence in health care. The most part of the respondents were satisfied with health care in hospital. More patients in Alytus hospital compared with Kaunas hospital patients confirmed that they did not trust health care policy, however were more satisfied with health care reform and services in hospital.

Adult↗
PubMed2004

[Heart assist (Vilnius University experience)].

Over the last three decades, the results of heart surgery have significantly improved. However, the number of patients at the last stages of heart deficiency has increased. Prevention provided to the patients suffering from heart diseases has improved the quality of their life and increased their lifetime. In spite of that, most of these patients sooner or later need a surgical treatment: heart surgery operation or heart transplantation. The visible damage to haemodynamics of the patients waiting for heart operations and particularly heart transplantations or after them has drawn the focus of heart surgeons to the mechanical systems of heart assist. In many cases they help to cure patients after post-cardiotomic or post-transplant cardiogenic progressive circulation and poly-organic deficiency. They also are regarded effective as a bridge to heart transplantation. In the Heart Surgery Center of Vilnius University, heart assist has been applied since 1976. Contrapulsation with intraaortic balloon pump has been applied to 856 patients, which after heart operations have developed progressive heart deficiency. Four methods of balloon insertion into aorta were used: through the a. iliaca incision (337 cases); through the a. femoralis punction (287 cases); through the ascending aorta (171 cases) and through the ascending aorta using tourniquets (61 cases). The best results were achieved employing intraaortic balloon pump after aorta-coronary bypass surgery: 67% patients were discharged from hospital. The worst results follow heart transplants, as intraaortic balloon pump was successful only to 28% of patients. In general, the total number of patients to whom the heart assist method was successful is 454 (53%). The second heart assist method that has been applied in our centre is the use of extracorporeal membranous oxigenator. It has been employed since 1998 to the patients with the critical respiration and heart deficiency. Extracorporeal membranous oxigenator has been used to 8 patients, to whom pharmaceutical treatment and intraaortic balloon pump were inefficient. Unfortunately, only one of the patients after 105 days was successfully disconnected from the extracorporeal membranous oxigenator, while maintaining his good haemodynamics. The third method of heart assist is the employment of artificial Berlin Heart ventricles. From 1999 up to 2003, 15 artificial Berlin Heart ventricles have been connected to thirteen patients, 7 of them as a bridge to heart transplant. One of the patients has already lived for over 2 years, while 6 patients had heart transplantation. There have been 8 post-cardiotomic patients with incorporated artificial Berlin Heart ventricles. The most experience has been accumulated in the use of intraaortic balloon pump. The fact that 53% of patients were discharged from hospital after such treatment indicates its efficiency. We have little experience in the employment of extracorporeal membranous oxigenator, therefore it is difficult to make conclusions. Whereas the application of Berlin Heart artificial ventricles is an effective method of assist circulation (heart assist), being a bridge to heart transplantation and effective in a long-term treatment.

Cardiac Surgical Procedures↗
PubMed2003

Truck driving and risk of myocardial infarction.

AIM OF THE STUDY: To investigated the effect ischemic heart disease of risk factors on elevated first myocardial infarction risk among truck drivers. MATERIALS AND METHODS: We carried out a case-control study among men aged 25-64, Kaunas in 1997-2000. We identified myocardial infarction cases (n = 448) from the myocardial infarction hospital register (International Classification of Diseases, 10-th revision, code 121). Controls (N = 1777) were selected on the basis of age, gender and city district of residence. We obtained information on sociodemographic, psychosocial and behavioral factors. We used the International Standard Classification of Occupations (ISCO) to code for occupations and conducted logistic regression analysis to evaluate the effect of ischemic heart disease risk factors on myocardial infarction risk for truck drivers. RESULTS: We found that truck rivers were at increased risk for the development of first myocardial infarction (age-adjusted odds ratio 2.36; 95% CI 1.67-3.35). After adjustment for smoking, hypertension, obesity, stress the odds ratio remained stable (2.26; 95% CI 1.58-3.24) as compared to other employed men. The logistic regression analysis within the subpopulation of truck drivers showed that the odds ratio for arterial hypertension was 3.20, for smoking--2.48. The effect of obesity and stress decreased to insignificant level. CONCLUSIONS: Truck drivers are at increased risk for the development of first myocardial infarction. Arterial hypertension and smoking are significant risk factors of myocardial infarction for truck drivers.

Adult↗
PubMed2004

[Analysis of burn-related deaths in Kaunas University of Medicine Hospital during 1993-2002].

UNLABELLED: Objective of this study was to investigate mortality of burned patients, treated in Kaunas University of Medicine Hospital during 1993-2002, changes of mortality, causes of death, to assess patients' age, gender, burn agent, and adjacent diseases. MATERIAL AND METHODS: Retrospective analysis of case-records of 283 burned patients deceased during 1993-2002 was done. RESULTS: During 1993-2002, 1876 burned adult patients were hospitalized in Kaunas University of Medicine Hospital. The mortality rate of burned patients was between 9 and 22% (average--13.3%, standard deviation--3.8). Age of deceased patients was on average 56 years (standard deviation--8); actually 21.6% were older that 80 years. There were 62% men among deceased burned patients. Common body surface area burned was 32% (standard deviation--28.6%), deep burn area was at average 22% (standard deviation--19.8%). Seventy two percent of burns were caused by fire, and 10% of patients were scalded. In 35% case-records adjacent diseases were not mentioned, in 57% atherosclerosis and ischemic heart disease were diagnosed, 5% of patients had respiratory diseases, 7% had central nervous system troubles, mental disorders were diagnosed in 2%. Eight percent were cachectic at admission, 6%--with chronic alcohol dependence. In 70% of patients pneumonia was diagnosed, in 13%--pulmonary edema, and in 39%--sepsis. Deceased patients were treated until death on average 14 days (standard deviation--6); during first two weeks 50% died. CONCLUSIONS: At higher mortality risk are elder burned patient with major burns, especially with serious adjacent diseases. Common death causes in burned patients are pneumonia, pulmonary edema and sepsis.

Adolescent↗
PubMed2004

[Fifty years of creative work (Society of Lithuanian Pathologists, 1954-2004)].

The article deals with the activity stages and forms of Society of Lithuanian Pathologists (in 1954-1991--Republic Scientific Society of Pathologoanatomists, in 1991-1996--Society of Lithuanian Pathologoanatomists). Founder of the Society and the first President (in 1954-1976) was prof. Janina Mackevicaite-Lasiene, in 1976-1996--prof. Elena Stalioraityte and since 1996 up till now--prof. Dalia Pangonyte. Taking into account the needs of medical research and practice, its activities varied. According to the tasks there are 4 stages of Society activity. The first--establishment of pathological practice, introduction into clinic and pathological practice of pathogenetic and nosologic diagnosis; the second--consolidation and development of pathological practice, conveyance of pathology knowledge, optimization of pathology teaching and training of specialists; the third--reforming of Society and pathological practice, widening of international relations; the fourth--introduction of recent methods and information technologies in pathological practice and teaching. The Society has organized ten republic conference and two congresses, four school-seminars, its members published 19 monographs and collections of articles, 6 textbooks, 28 learning books, 26 methodical recommendations, more than fifty members acquired academic degree.

History, 20th Century↗
PubMed2004

Lactose malabsorption in young Lithuanian children with atopic dermatitis.

AIM: To determine the prevalence of lactose malabsorption in young Lithuanian atopic dermatitis children; to evaluate the relationship between lactose malabsorption and the duration of exclusive breastfeeding, and the relationship between lactose malabsorption and cow's milk intolerance in parents and grandparents. METHODS: 144 children with atopic dermatitis aged 1.5-24 mo (study group) and 32 children without symptoms of allergic diseases aged 1.5-23 mo (control group) were investigated. Lactose and glucose-galactose absorption tests based on serial blood glucose determination, culture of stool, latex agglutination test for rotavirus and microscopic examination of stool for parasites were performed. RESULTS: Lactose malabsorption was determined in 59 (40.9%) and glucose-galactose malabsorption in 17 (11.8%) children with atopic dermatitis. The risk of developing lactose malabsorption was higher in children fed exclusively on breast milk up to 1 mo of age than in children fed exclusively on breast milk for 4 to 6 mo (OR: 2.62; 95% CI: 1.02-6.75). Lactose malabsorption was significantly more frequent in patients whose mothers did not tolerate cow's milk (20/30; 66.7%) than in patients whose mothers were tolerant to it (39/95; 41.1%) (p = 0.02). CONCLUSION: Lactose malabsorption was determined in 40.9% of Lithuanian atopic dermatitis children aged under 2 y. Lactose malabsorption appeared to be associated with the duration of exclusive breastfeeding up to only 1 mo and mothers' milk intolerance.

Child, Preschool↗
PubMed2004

[Methodological aspects of health-related quality of life assessment].

Despite the increasing interest of Lithuanian health care professionals in measurement of health-related quality of life, there is a lack of medical literature in Lithuanian that describes methodological issues of quality of life assessment. Main psychometric properties of questionnaires (validity, reliability, and responsiveness), as well as methods of their establishment are discussed in this review of international literature. Criteria for selection of a measurement instrument are provided, issues of interpretability of scores and "minimal clinically significant difference" are described in this article. Increase in demand of health-related quality of life questionnaires across medical specialities during the last decade and problems of cross-cultural adaptation of instruments are briefly reviewed.

Adolescent↗