Associations between neighbourhood greenness and asthma in preschool children in Kaunas, Lithuania: a case-control study.

OBJECTIVES: The aim of this study was to investigate the associations between surrounding greenness levels and asthma among children, and to explore a possible change of this association by the distance of the residence to a city park. DESIGN: A nested case-control study. SETTING: Children aged 4-6 years residing at their current address since birth in Kaunas, Lithuania, whose mothers were recruited in 2007-2009 to the KANC newborns cohort study. PARTICIPANTS: The participants were 1489 children whose parents in 2012-2013 filled in the questionnaires and agreed to participate in the study. PRIMARY AND SECONDARY OUTCOME MEASURES: We estimated clinically diagnosed asthma risk factors. The surrounding greenness was measured as the average of the satellite-based Normalised Difference Vegetation Index (NDVI) within the buffers of 100, 300 and 500 m from each child's home address, and the distance to a city park was defined as the distance to the nearest city park. Multivariate logistic regression was performed to study the relationship between the greenness exposures and asthma adjusted for relevant covariates. RESULTS: An increase in the NDVI (>median) in buffers of 100, 300 and 500 m was associated with a slightly increased risk of asthma, while an IQR increase in NDVI-100 m statistically significantly increased the risk of asthma (OR 1.43, 95% CI 1.10 to 1.85). The stratified analysis by surrounding greenness revealed indications of stronger associations for children with higher surrounding greenness (NDVI-100>median) and those living farther away from parks (>1000 m), compared to NDVI-100≤median and the distance to a city park >1000 m (OR 1.47, 95% CI 0.56 to 3.87). CONCLUSIONS: A higher level of the surrounding greenness was associated with a slightly increased relative risk of asthma in children. Further investigation is needed to elucidate the influence of city parks and neighbourhood greenness levels on asthma.

The impact of tobacco smoke exposure on wheezing and overweight in 4-6-year-old children.

AIM: To investigate the association between maternal smoking during pregnancy, second-hand tobacco smoke (STS) exposure, education level, and preschool children's wheezing and overweight. METHODS: This cohort study used data of the KANC cohort--1,489 4-6-year-old children from Kaunas city, Lithuania. Multivariate logistic regression was employed to study the influence of prenatal and postnatal STS exposure on the prevalence of wheezing and overweight, controlling for potential confounders. RESULTS: Children exposed to maternal smoking during pregnancy had a slightly increased prevalence of wheezing and overweight. Postnatal exposure to STS was associated with a statistically significantly increased risk of wheezing and overweight in children born to mothers with lower education levels (OR 2.12; 95% CI 1.04-4.35 and 3.57; 95% CI 1.76-7.21, accordingly). CONCLUSIONS: The present study findings suggest that both maternal smoking during pregnancy and STS increase the risk of childhood wheezing and overweight, whereas lower maternal education might have a synergetic effect. Targeted interventions must to take this into account and address household smoking.

Rare refractory Kawasaki disease in an adolescent boy with cardiac and diffuse coronary artery involvement.

Kawasaki disease is an acute multisystemic vasculitis occurring predominantly in infants and young children and rarely in adolescents and adults. At elderly age, Kawasaki disease may remain unrecognized with a subsequent delay in appropriate therapy and an increased risk of coronary artery aneurysms. We report a case of intravenous immunoglobulin- and aspirin-resistant Kawasaki disease and severe cardiovascular damage in an adolescent boy. The article discusses major issues associated with the management of refractory Kawasaki disease.

Factors associated with breastfeeding duration.

BACKGROUND AND OBJECTIVE: The assessment of the factors associated with breastfeeding duration helps in creation of a national policy according to the World Health Organization strategy and recommendations. The objective of the study was to identify the factors associated with breastfeeding duration. MATERIAL AND METHODS: These analyses are based on a sample of mothers with babies attending one family health center in Kaunas, Lithuania. Completed questionnaires were obtained from 195 mothers (response rate, 97.5%). One year later, the same respondents, who had 1-year-old children, answered questions of the second questionnaire. RESULTS: Half (53.8%) of the surveyed women breastfed for 3-5 months, 29.7% for 6 months and more, and 16.5% of the respondents breastfed for less than 3 months. The oldest (31-40 years) women breastfed their babies significantly longer than the youngest (<20 years) mothers. The mothers with a higher education breastfed their babies significantly longer than the less educated mothers. The married women breastfed longer than single or living with a partner. The mothers who did not give extra fluids and pacifiers breastfed significantly longer than the women who gave them. The majority of the mothers who had sore nipples, milk stasis, and mastitis breastfed for only up to 3 months. CONCLUSIONS: Mothers at risk of short breastfeeding duration should be targeted as a group for breastfeeding promotion early in the pregnancy. The education of healthcare professionals who provide prenatal and postnatal care allows them to choose women who need additional breastfeeding support.

The evaluation of knowledge and activities of primary health care professionals in promoting breast-feeding.

UNLABELLED: The objective of this study was to evaluate the knowledge and activities of Kaunas primary health care center professionals in promoting breast-feeding. MATERIAL AND METHODS: A total of 84 general practitioners and 52 nurses participated in the survey, which was carried out in Kaunas primary health care centers in 2006. Data were gathered from the anonymous questionnaire. RESULTS: Less than half of general practitioners (45.1%) and 65% of nurses were convinced that baby must be exclusively breast-fed until the age of 6 months, but only 21.6% of general practitioners and 27.5% of nurses knew that breast-feeding with complementary feeding should be continued until the age of 2 years and longer. Still 15.7% of general practitioners and 25% of nurses recommended pacifiers; 7.8% of general practitioners advised to breast-feed according to hours. Half of the health professionals recommended additional drinks between meals; one-third of them--to give complementary food for the babies before the age of 6 months. One-third (29.6%) of the health professionals surveyed recommended mothers to feed their babies more frequently in case the amount of breast milk decreased. CONCLUSIONS: The survey showed that knowledge of medical personnel in primary health care centers about the advantages of breast-feeding, prophylaxis of hypogalactia, and duration of breast-feeding was still insufficient.

Time trends in the prevalence of asthma and allergy among 6-7-year-old children. Results from ISAAC phase I and III studies in Kaunas, Lithuania.

OBJECTIVE: To assess the changes in the prevalence of asthma and allergy in 6-7-year-old schoolchildren in Kaunas, Lithuania, using the International Study of Asthma and Allergy in Childhood (ISAAC) core questionnaire. MATERIAL AND METHODS: Two cross-sectional surveys (1994/1995-2001/2002) according to the ISAAC protocol were carried out. Lithuanian version of the ISAAC core questionnaire was completed by parents randomly selected from Kaunas primary schools. A school-based sample of 1879 participants in the 1994/1995 survey and 2772 participants in the 2001/2002 survey was study population. RESULTS: The response rates in 1994 and 2002 were 93.95% and 92.4%, respectively. There is a tendency towards an increase in the prevalence of current symptoms and diagnoses for all three conditions, but it was more pronounced in boys. Significant increases in the prevalence of asthma (0.9% vs 2.6%), allergic rhinitis (1.4% vs 2.4%), and atopic dermatitis (1.4% vs 3.5%) were observed comparing two surveys. Still a lot of allergic diseases remain undiagnosed. CONCLUSIONS: Our study shows that the prevalence of symptoms of asthma, allergic rhinitis, and atopic dermatitis is increasing, reflecting the changes in morbidity from these conditions in our country.

[Consensus on asthma diagnosis and treatment in children and adults]. / Vaiku ir suaugusiuju astmos diagnostikos ir gydymo sutarimas.

Asthma is a chronic airway disease that is a growing problem of public health. The current consensus is based on the Global Initiative for Asthma (GINA) and other guidelines for asthma, and adapted for Lithuania. This Consensus provides physicians with recommendations for asthma management in children and adults.