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PubMed2004

[Trends of main risk factors of coronary heart disease in Kaunas population during 20 years (the data of the MONICA study)].

MONICA (Multinational MONItoring trends and determinants of CArdiovascular diseases) study was carried out in Kaunas in 1983-2002 in four random samples of population aged 35-64 years (overall 3292 men and 3548 women - response rate 65.1%). Over the 20-year period, mean levels of systolic blood pressure (BP) (in men and women), diastolic BP (in women), body mass index (in men and women) decreased while mean levels of total serum cholesterol increased (in men and women). In the final survey as compared with initial survey arterial hypertension (AH) (BP > 140/90 mm Hg) became less prevalent in women (39.4% and 51.3%, p<0.001) and mild hypertension - less prevalent in men (25.9% and 33%, p<0,001). Over the study period, prevalence of mild hypercholesterolemia (total cholesterol 5.0-6.49 mmol/l) decreased and prevalence of severe hypercholesterolemia (total cholesterol =7.8 mmol/l) increased both in men and women. The prevalence of excessive weight increased in men and the prevalence of obesity increased in women. No statistically significant changes were detected in the prevalence of smoking in men during the study period while in women the prevalence of regular smoking increased (from 4.1% to 11.3%, p 0,001). The observed levels and trends of main risk factors of coronary heart disease require intensification of implementation of primary prevention measures in the studied population.

Adult↗
PubMed2004

Evaluating average expenditures per case in Kaunas University of Medicine Hospital.

The aim of the study was to evaluate average expenditures per case in Kaunas University of Medicine Hospital (KUMH). Case is defined as one treatment episode in particular inpatient department. Five cost groups have been used and defined in monetary terms in each clinical category (profile): labor costs; medication costs; laboratory, radiology and anesthesiology (for surgical clinics) services costs; running costs of medical equipment supply; other costs (including costs of patients' meal, laundry, transportation, communication, auxiliary services, heating, electricity, water, buildings maintenance and repair, etc.). Cases were analyzed using case mix dimensions: gender, age, absence or presence of surgical operation, patient separation status and inpatient service groups. During the study average expenditures per case were estimated: surgery--1161.10 Litas, therapy--1312.15 Litas, obstetrics and gynecology--685.82 Litas, newborn and child care--893.54 Litas and intensive care--1292.92 Litas. Relation between expenditures and case mix variables was measured using correlation analysis method. Using multiple regression analysis method, expenditures per case in each clinical category (profile), according case mix dimensions were predicted. Predicted expenses did not differ much from estimated cost per case.

Adolescent↗
PubMed2004

The patient role in decision-making in Lithuanian health care.

UNLABELLED: The objective of the study is to explore the attitudes of Lithuanian citizens to health care system and to evaluate their social role in decision-making about their health care. MATERIAL AND METHODS: The national cross-sectional survey was conducted March 1-7, 2004. Multi-stage random sampling across the country included adult Lithuanian residents, interviewed in their home (n=1007). The response rate was 56.5%. The attitudes of citizens were evaluated using an anonymous questionnaire, originally developed and adopted with the reference to experience of previously conducted studies. RESULTS: Majority of polled women and men (84.6% and 72.6%) recognized health as very important value in their life and as the most important among other social values. The overall mean of trust in health care system - 41.3%, trust in physicians - 69.9%, implementation of right to health care - 48.9%, concern about health care - 96.5% and patient impact in health care decisions - 19.1%. Nearly half of respondents (47.4%) prefer informative general practitioner-patient interaction model, which is realized in most cases (58.8%). Partnership (shared decision-making) as interaction model is expected by 37.2% of polled respondents and realized in every sixth case in primary care. CONCLUSIONS: Health as value is the most preferred among Lithuanian citizens. Younger and more educated people trusted less in health care system, but are more motivated to play an active role in health care decision-making. The informative model of doctor-patient is dominant, while partnership is not so exposed as being expected by patients.

Adolescent↗
PubMed2004

[Falls in early in-patient rehabilitation of stroke patients].

Early in-patient rehabilitation is a basis for functional state improvement in patients with cerebral stroke (CS). The influence of the falls on the efficacy of early in-patient stroke rehabilitation is demonstrated. The incidence of falls among the patients with concomitant complications was 35.6%, in 3.4% of them hip fracture being observed. Patients with disturbances of orientation, coordination and mental abilities, especially in the cases of right hemisphere lesions, fall more frequently because of inadequate- or over estimation of their abilities. In this group, the indices of rehabilitation efficacy were lower that allowed to highlight the problem of falls in the patients with cerebral stroke at the early in-patient stage of rehabilitation.

Accidental Falls↗
PubMed2004

Sequential organ failure assessment score as the determinant of outcome for patients with severe sepsis.

AIM: To evaluate the impact of organ dysfunction in severe sepsis and determine the effectiveness of organ dysfunction scores to discriminate outcome after admission to the intensive care unit (ICU). METHODS: Patients with a diagnosis of severe sepsis and at least one organ dysfunction on the first day in the ICU (n=117) were included in the prospective observational study. The presence of organ dysfunction was assessed using a Sequential Organ Failure Assessment (SOFA). The severity of illness was assessed using a Simplified Acute Physiology Score (SAPS) II during the first 24 hours after the admission to the ICU. The main outcome was survival status on day 28 after admission to the ICU. RESULTS: Most common sites of infection were intra-abdominal and respiratory system (77 and 38 cases, respectively). Median SAPS II score on admission was 47 points (25th-75th quartiles range, 37-57 points). Twenty eight days survival rate was 41%. The best discrimination results were shown for cumulative scores with the highest for the SOFA score on day 3 in the ICU. The ability to discriminate outcome on day 1 was weak for the presence of dysfunction in all organ systems except neurological. The discriminative power of organ dysfunction scores increased during the stay in the ICU. Neurological and cardiovascular dysfunctions were the independent risk factors for mortality. CONCLUSION: The SOFA scores showed high accuracy in describing the course of organ dysfunction for the patients with severe sepsis. Evolving organ dysfunction following admission to the ICU strongly affected the outcome. Cumulative SOFA scores were better in discriminating outcome compared to single organ dysfunction scores.

Aged↗
PubMed2004

[Development of research at the Institute of Oncology of Vilnius University].

Today the Institute of Oncology of Vilnius University continues the scientific activities of the former Lithuanian cancer research institutions. The main mission of the Institute is to perform fundamental and applied research in the field of oncology. In addition, the Institute helps Vilnius University to train oncology specialists and researchers as well as provides health care services. The main scientific activities of the Institute of Oncology are the following: development of tumor prevention based on epidemiologic, experimental, molecular and clinical investigations; development of new technologies and methods of early cancer detection and treatment; and improvement of the quality of life of cancer patients. The summary of the most important research and development projects in the Institute of Oncology is presented in this paper.

Academies and Institutes↗
PubMed2005

[Psychological state of abused children of risk group].

The aim of this study was to describe the psychological peculiarities of physically abused schoolchildren of risk group. The survey was based on the data gathered using anonymous questionnaire. Indicators, chosen for evaluation of psychological well-being of schoolchildren, were the following: loneliness, happiness, ability to make contacts and socialize with peers, sense of coherence, self-esteem, and suicidal tendencies. The sample of 211 schoolchildren, aged 10 to 16 year from seventeen Kaunas secondary schools participated in the survey. The sampling was made on the basis of lists of socially and pedagogically neglected schoolchildren. It has been established that psychological well-being of physically abused schoolchildren, in comparison with the ones not abused, was worse. Physically abused children more often felt loneliness and unhappiness, found it more difficult to make friends, were more often characterized by low self-esteem and weak sense of coherence. The relationship between physical abuse and suicidal tendencies was established; suicidal tendencies among physically abused schoolchildren were six times more frequent than among those, who did not suffer violence (78.5% and 12.5%). Almost all schoolchildren, attributed to the group with high risk for suicide, were physically abused (29.0% and 1.9%, respectively).

Adolescent↗
PubMed2004

Web-based health services and clinical decision support.

The purpose of this study was the development of a Web-based e-health service for comprehensive assistance and clinical decision support. The service structure consists of a Web server, a PHP-based Web interface linked to a clinical SQL database, Java applets for interactive manipulation and visualization of signals and a Matlab server linked with signal and data processing algorithms implemented by Matlab programs. The service ensures diagnostic signal- and image analysis-sbased clinical decision support. By using the discussed methodology, a pilot service for pathology specialists for automatic calculation of the proliferation index has been developed. Physicians use a simple Web interface for uploading the pictures under investigation to the server; subsequently a Java applet interface is used for outlining the region of interest and, after processing on the server, the requested proliferation index value is calculated. There is also an "expert corner", where experts can submit their index estimates and comments on particular images, which is especially important for system developers. These expert evaluations are used for optimization and verification of automatic analysis algorithms. Decision support trials have been conducted for ECG and ophthalmology ultrasonic investigations of intraocular tumor differentiation. Data mining algorithms have been applied and decision support trees constructed. These services are under implementation by a Web-based system too. The study has shown that the Web-based structure ensures more effective, flexible and accessible services compared with standalone programs and is very convenient for biomedical engineers and physicians, especially in the development phase.

Adult↗
PubMed2004

Cardiological telemonitoring in rehabilitation and sports medicine.

The paper presents the development results of teleconsultative cardiology systems and their application in rehabilitation and sport medicine. The first teleconsultative cardiology (TELECARD) system was developed for outpatient departments in the city of Kaunas, using Internet links. It was based on the CompCardioSignal terminal. One branch of the TELECARD system with a mobile CompCardioSignal terminal was used for functional state evaluation of Lithuanian sportsmen during the 2000 Sydney Olympic Games. The examined results have shown that every sportsman responded differently to acclimatization and the TELECARD system provided support to physicians and coaches for making optimal decisions regarding the sportsmen's adaptation and other situations. The final telemetry system was used for rower monitoring. It was based on the new CompCardioSignal terminal with three EASI ECG leads and synchronously recorded motion signals for evaluation of human reaction to physical load. The developed telemonitoring systems were a useful tool for evaluation of human reaction to physical load in rehabilitation and sports activities.

Computer Systems↗
PubMed2004

Development of teleconsultations systems for e-health.

Two prototype telemedicine systems have been developed: 1) a wireless system for status assessment of cardiology patients (WSCP), 2) a system for medical image management and teleconsultations (IMTS). The former system enables the patient to record an ECG on a personal digital assistant (PDA), view it and send it via a wireless connection. The doctor on duty is then able to view the received ECG and make appropriate decisions, also to apply for consultation by sending the received ECG to the PDA of a cardiology expert. The system logs all performed operations. The hardware used in the system consists of personal computers (PCs), PDAs, analog-digital converters, ECG sensors and GPRS modems. Software consists of programs for patients, doctors on duty, cardiology experts and administration, along with a central database. The second system is intended to be used by professional doctors for management of collected images and for teleconsultations via videoconferencing in order to obtain a second opinion. The system provides an integrated environment eliminating the need to jump between many applications. By using the system, doctors are able to acquire images from analog and digital cameras, process and enhance them, as well as upload them to local or remote databases. Doctors are also able to design custom database forms. The teleconsultation part of the system supports video and audio over ISDN and TCP-IP, using both a hardware codec (Zydacron Z360) and a software codec (based on MS Netmeeting). Images are sent from one client to another using the standard protocol T.120. Images become synchronized immediately upon reception by another client.

Computers, Handheld↗
PubMed2005

[Assessment of quality of life in the middle-aged Kaunas population].

UNLABELLED: The aim of this study was to evaluate validity and reliability of the WHOQOL-100 questionnaire in the middle-aged Kaunas population and to assess quality of life among men and women and age groups. MATERIAL AND METHODS: The random sample consisted of 1347 Kaunas men and women aged 35-64 and stratified by age and sex (response rate 62%). They were examined in 2001-2002 using self-administered of the WHOQOL-100 questionnaire. Approval from the Ethics Committee of Kaunas University of Medicine was obtained and participants signed a written informed consent prior to filling in a questionnaire. The direct method was used for age standardization using European population as a standard. Validity and reliability of the questionnaire were evaluated by Pearson's correlation coefficients and by Cronbach's alfa. RESULTS: The reliability of the questionnaire among items was found to be very high for all domains (Cronbach's alfa from 0.77 to 0.91). The retest reliability was high or very high for all domains (0.64-0.89). Women scored lower in all domains as compared to men, except spirituality (p<0.001). The scores of the questionnaire decreased with age among both men and women. Women aged 45-54 scored lower in the quality of life, physical and independence level domains, whereas men were lower in the social relationship and spirituality domains as compared to the youngest group (p<0.05). CONCLUSION: The WHOQOL-100 questionnaire is a reliable and valid measure of quality of life in the middle-aged Kaunas population; older age and female gender are the determinants of worse quality of life.

Adult↗
PubMed2005

[Trends in morbidity from acute myocardial infarction, risk factors and risk of ischemia].

THE AIM: To assess the linkages of trends between the mean values of main risk factors of ischemic heart disease, the overall high risk of coronary within 10 years and morbidity from acute myocardial infarction in Kaunas population aged 35-64 years during the period from 1983 to 2002. MATERIAL AND METHODS: Data sources were four cross-sectional surveys (1983-1984, 1986-1987, 1992-1993, 2001-2002) and population-based ischemic heart disease register (1983-2001) of Kaunas population aged 35-64 years. Data collection was conducted according to the method using in the Multinational Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) project. The overall high risk developing a fatal or non-fatal myocardial infarction or sudden death within 10 years was calculated by PROCAM Risk Score. RESULTS: During 1983-2002 the mean value of systolic blood pressure decreased among men and women (respectively, from 138.8 to 136.4 mmHg, p<0.05 and from 139.7 to 133.2 mmHg, p<0.05). Body mass index decreased among men (from 27.5 to 27.4 kg/m2, p<0.05), and diastolic blood pressure decreased among women (from 86.5 to 82.7 mmHg, p<0.05). In 1983-2002 the overall high 10-year risk also decreased in men and women (respectively, from 20.4 % to 16.3% and from 7.9% to 5.4%). During 1992-2001 the trend of morbidity from acute myocardial infarction was declining among men (by - 4.6 %/year, p<0.01) and among women (by--1.3 %/year, p>0.05). CONCLUSION: Trends of the overall high 10-year coronary risk and morbidity from acute myocardial infarction were analogous in both genders.

Adult↗
PubMed2005

[Major cardiovascular diseases mortality in Kaunas population for 1983-2002].

AIM: To evaluate trends in mortality of ischemic heart disease (IHD) and stroke in Kaunas population aged 25-64 years in 1983 to 2002. MATERIAL AND METHODS: The study based on official mortality statistics covered all residents of Kaunas aged 25-64 years who died of IHD and stroke in 1983-2002. Age-standardized rates were calculated by the direct method and using European population as a standard. The trends were analysed using the method of linear regression on logarithms of the age-standardized annual rates. RESULTS: In 1983-2002, IHD and stroke mortality rates were significantly decreasing both for men and women (by 2.2%/yr, p = 0.003, and 2.9%/yr, p = 0.004, respectively, for men and by 2.6%/yr, p = 0.005 and 3.2%/yr, p = 0.002, respectively, for women). CONCLUSION: In 1983-2002, both IHD and stroke mortality rates among both Kaunas men and women aged 25-64 years decreased significantly.

Adult↗
PubMed2005

[Adaptation of health-related quality of life ("SF-36") questionnaire, its validation and assessment of performance for control group and patients with rheumatoid arthritis].

OBJECTIVE: To adapt the Lithuanian "SF-36" questionnaire, to assess psychometric and life quality criteria for patients with rheumatoid arthritis and for control group. MATERIAL AND METHODS: Linguistic and cross-cultural adaptation of the Lithuanian "SF-36" questionnaire was made on the basis of the stages referred to in the international project of health quality assessment. For the evaluation of psychometric criteria, data from Vilnius rheumatoid arthritis register (502 patients) and those of the control group (83 people) were used. The reliability of "SF-36" questionnaire was assessed by determining homogeneity, internal consistency of scales and scale stability in time and by calculating the intraclass correlation coefficient. Face, contents and construct validity of the "SF-36" questionnaire has been evaluated, as well as the quality of life of patients with rheumatoid arthritis and those of the control group. RESULTS: After making linguistic and cultural adaptation of the questionnaire, its final version has been prepared. In assessing the homogeneity of "SF-36", a high and middle-sized correlation between different items of the questionnaire has been noticed in the control group (r=0.51-0.71) and in patients with rheumatoid arthritis (r=0.57-0.83). Internal consistency for the items was also good enough (Kronbach alpha=0.79-0.85) for both tested groups. Stability in time was high for all items of the questionnaire, for the exception of vitality (r=0.074). Face and contents validity of the questionnaire is rather good. Estimates of the correlation between items of the quality of life questionnaire and other questionnaires have shown good convergent and discriminant construct validity. Evaluations of the quality of life in almost all spheres, except emotional, by patients with rheumatoid arthritis were worse than by the rest. CONCLUSIONS: Questions of health-related quality of life questionnaire are easy to understand and acceptable for the respondents. Reliability and validity of the questionnaire is rather high. For the exception of emotional status, quality of life in almost all spheres was considered as bad by patients with rheumatoid arthritis. The control group had more complaints about the emotional status.

Arthritis, Rheumatoid↗
PubMed2005

Assessing the validity of cardiac surgery risk stratification systems for CABG patients in a single center.

BACKGROUND: Most cardiac surgery risk stratification systems were primarily designed using patient-related factors to predict mortality and postoperative morbidity. Relative mortality rates are higher at cardiac surgery centers which perform surgery on elderly patients. Our aim was to assess the validity of risk stratification systems for our regional population. MATERIAL/METHODS: The study involved 1021 patients. Risk stratification was carried out using the EuroSCORE, Ontario, and QMMI scoring systems. Analysis comparing the scoring systems included sensitivity, specificity, predictive values, and receiver operating characteristics (ROC) curves. Accuracy was assessed using the systems' ability to avoid Type I and Type II errors. RESULTS: Sensitivity and specificity of the QMMI scoring system were 33.3% and 97.2%, of EuroSCORE 20.7% and 96.7%, and of Ontario 21.1% and 94.4%, respectively. The best positive predictive value was for QMMI and EuroSCORE with 75% versus Ontario's 50%. The highest negative predictive value was QMMI's 85.4% versus Ontario's 78.9% and EuroSCORE's 72.0%. The best accuracy showed QMMI scoring with 84.5% versus Ontario's 78.9% and EuroSCORE's 72.2%. CONCLUSIONS: All the investigated risk stratification systems were moderately predictive. The QMMI score showed the best predictive characteristics (sensitivity, specificity, and accuracy) for our patient population. The QMMI system had high specificity and accuracy. The EuroSCORE system showed mortality overprediction for our population, associated with high false negative test results and low accuracy. The Ontario risk stratification system often commits Type II errors, associated with a high rate of false positive test results and low accuracy.

Age Factors↗