Migration intentions of Lithuanian physicians, nurses, residents and medical students.

Due to a flow of healthcare professionals and students from emerging to industrialized economies, healthcare systems in source countries are facing increasing threats to a people-centered quality of care. This study investigates the prevalence and underlying reasons for emigration intentions among physicians, nurses, residents, and medical students in Lithuania (total N = 1080). In our sample, 39% of students, 21% of residents, 12% of nurses, and 6% of physicians had decided to emigrate within the next two years. Based on statistical analyses of the survey data, we conclude that emigration decisions are linked to socio-demographic (age, gender, family situation), financial, organizational (teamwork climate in hospital) and social (perceived social worth) factors. Implications for policy-making and retention of healthcare workforce are discussed.

Trends in the Attack Rates, Incidence, and Mortality of Stroke during 1986-2012: Data of Kaunas (Lithuania) Stroke Registry.

BACKGROUND: There is a lack of reliable epidemiological data on longitudinal trends in stroke attack rates, incidence, and mortality in the countries of the Baltic region. AIMS: The aim of the present study was to explore the longitudinal trends of stroke in middle-aged urban population of Lithuania during the period of 1986 through 2012. METHODS: All stroke events in the studied population were ascertained and validated according to the standardized criteria outlined by the WHO MONICA Project. The study included all patients in Kaunas (Lithuania) city aged 25 to 64 years who experienced a stroke between 1986 and 2012. Estimates of time-trends of the annual percentage change in stroke attack rates, incidence of stroke, and mortality from this condition were made by applying the Joinpoint regression analysis. RESULTS: During the study period, 9,992 stroke events were registered. The overall proportion of recurrent events was 25.7%. Overall, 18.9% of the events (20.0% in men, and 17.4% in women) were fatal within 28 days. During the period of 1986 to 2012, a flat trend in the incidence of stroke was observed among both male and female middle-aged inhabitants of Kaunas city, while attack rates were increasing due to the increase in recurrent strokes. Both mortality and 28-day case fatality of stroke declined significantly over the study period in both sexes. CONCLUSIONS: An increase both in the incidence and recurrence of stroke among middle-aged men residing in Kaunas city and in the recurrence of stroke among women denotes the inefficiency of measures applied both for primary and secondary prevention of stroke in Lithuania. The revision of current prevention strategies and the introduction of new ones are of paramount importance in order to fight the epidemic of stroke.

Trends in out-of-hospital ischemic heart disease mortality for the 25-64 year old population of Kaunas, Lithuania, based on data from the 1988-2012 Ischemic Heart Disease Registry.

AIM: The aim of the study was to evaluate trends in out-of-hospital ischemic heart disease (IHD) mortality in the Kaunas, Lithuania population aged 25-64, from 1988 to 2012. METHODS: The registry was maintained according to the World Health Organisation (WHO) recommendations for the multinational MONICA (MONItoring of trends and determinants in CArdiovascular disease) project. We analysed out-of-hospital deaths from IHD, by sex and age groups, using the linear logistic regression model for identifying trends. RESULTS: In 1988-2012, the out-of-hospital IHD deaths in Kaunas accounted for 78.4% and 68.4%, on average, of all IHD deaths in men and women aged 25-64, respectively. During the study period, the out-of-hospital IHD mortality for the Kaunas population aged 25-64 was 134.5 per 100,000 men and 18.2 per 100,000 women. From 1988 to 2012, the out-of-hospital IHD mortality for men and women aged 25-64 tended to decline by, on average, 8.3% per year (p = 0.269) and 16.2% per year (p = 0.101), respectively; whereas the corresponding rates for men aged 25-44 were declining significantly, by 22.5% per year (p = 0.047). The most significant changes in out-of-hospital IHD mortality were among men aged 25-44 with no previous history of acute myocardial infarction (AMI), in whom the out-of-hospital IHD mortality was significantly declining, by 21.3% per year (p = 0.015); whereas the corresponding rates for men aged 45-54 with a previous history of AMI tended to decline by 20.4% per year (p = 0.114). CONCLUSIONS: In 1988-2012, the out-of-hospital IHD deaths of younger men and middle-aged women accounted for the highest percentage of all IHD deaths; and a higher proportion of both men and women with no previous history of AMI, as compared to the proportion of those with a previous history of AMI.

The cost of newly diagnosed breast cancer in Lithuania, 2011.

BACKGROUND AND OBJECTIVE: Although the cost of treating women with breast cancer (BC) is an important component for cost saving and effectiveness in relation to the benefits of BC treatment interventions, there is limited information on the direct cost reported for BC in Lithuania. Therefore the aim of this study was to evaluate annual direct medical cost for newly diagnosed BC in Lithuania in the year 2011. MATERIALS AND METHODS: The retrospective incidence-based top-down direct cost analysis was used. From January 1 to December 31, 2011 incident cases of BC (N=1142) registered by the National Health Insurance Fund, the stage determined by Lithuanian Cancer Registry were included in the study. RESULTS: The total average direct cost of BC amounted per patient was 2580 (95% CI 2444-2752)EUR in 2011. The main cost driver per BC patients was the inpatient hospital stay, respectively 1655 (95% CI 1478-2334)EUR. The average outpatient cost for one BC patient was 564 (95% CI 547-898)EUR. The dominant proportion of inpatient expenditures was assigned to BC surgery and chemotherapy treatment. The BC direct medical cost increased according to the diagnosed stage of diseases from 2409 (95% CI 2196-2621)EUR in stage 1 to 3688 (95% CI 2703-4672)EUR in stage 4. The direct medical cost was inversely proportional to age. CONCLUSIONS: The direct BC medical cost estimates provided by this analysis can be used to determine priorities for the future research on BC treatment interventions.

Associations between parental skills and their attitudes toward importance to develop good oral hygiene skills in their children.

BACKGROUND: For many years, poor oral hygiene and frequent consumption of sugars is known as key behavioral risk factors for oral diseases, such as dental caries and periodontal disease. Parental attitudes toward children's oral health could be associated with their own oral health skills. We aimed to analyze associations between parental skills and attitudes toward caries development and possibilities to control positive oral health behavior in their children. MATERIAL AND METHODS: A cross-sectional study involved 550 parents of 3- to 4-year-old children. A 40-item questionnaire was developed from the Theory of Planned Behavior, Health Belief Model and the Health Locus of Control model, and parental attitudes toward dental caries in their children were analyzed. RESULTS: A total of 397 filled-in questionnaires were collected; the response rate was 72%. Parents with good own oral hygiene skills significantly more often understood the importance of brushing their children's teeth (chi(2)=29.8; df=1; P<0.001). Study results highlighted also significant differences in importance to prevent tooth decay (chi(2)=3.1; df=1; P=0.051), importance to control sugar snacking (chi(2)=10.6; df=1; P=0.001), and parental perceived seriousness of tooth decay in children (chi(2)=9.2; df=1; P=0.002) comparing parents with poor and good oral hygiene skills. Differences in parental efficacy to control proper toothbrushing and parental efficacy to control sugar snacking in children were not significant comparing both groups. CONCLUSIONS: More than half (61%) of the parents have reported appropriate own oral hygiene skills. Parental attitudes toward children's oral health were significantly associated with their own oral health behavior and understanding the importance of development of oral hygiene skills in their children.

Home sampling and pooling of vaginal samples are effective tools for genetic screening of Chlamydia trachomatis among high school female students in Lithuania.

The aims were 1) to estimate the prevalence of C. trachomatis infection among sexually active female students in Kaunas, Lithuania; 2) to investigate the usefulness of personal invitation, self-sampling, and pooling of samples for screening; and 3) to evaluate the costs of the approaches used. A cross-sectional study inviting 795 female students (18-31 y of age) from 7 high schools and 1 college in Kaunas was performed. The response rate was 67% (533/795). Self-obtained vaginal samples were analysed, individually and pooled (n = 3), using Digene Hybrid Capture II CT/NG Test. The overall prevalence of C. trachomatis infection was 5.6%. Among the sexually active female students 20-24 y of age (n = 424), the prevalence was 7.1%; however, the prevalence varied from 0% to 14.2% at the different schools. For estimation of the population prevalence based solely on identification of C. trachomatis positive pools, the pooling strategy reduced the costs by 85%. For estimation of population prevalence and for diagnosis of each individual sample, pooling reduced the costs by 70%. Targeted screening, using pooling to reduce the expenses, mainly of 3rd and 4th y Lithuanian female students could be recommended. By extended personal contact and internet-based communication, increased participation rates may be attained.

Primary care in a post-communist country 10 years later Comparison of service profiles of Lithuanian primary care physicians in 1994 and GPs in 2004.

OBJECTIVES: The study aimed, firstly, to assess changes in the service profile of primary care physicians between 1994, when features of the Soviet health system prevailed, and 2004, when retraining of GPs was completed. Secondly, to compare service profiles among current GPs, taking into account their positions before being retrained. METHODS: A cross-sectional repeated measures study was conducted among district therapists and district pediatricians in 1994 and GPs in 2004. A questionnaire was used containing identical items on the physicians' involvement in curative and preventive services. The response rates in both years were 87% and 73%, respectively. RESULTS: In 2004, physicians had much more office contacts with patients than in 1994. Modest progress was made with the provision of technical procedures. Involvement in disease management was also stronger in 2004 than in 1994, particularly among former pediatricians. Involvement in screening activities remained stable among former therapists and increased among former pediatricians. At present, GPs who used to be therapists provide a broader range of services than ex pediatricians. GPs from the residency programme hold an intermediate position. CONCLUSIONS: Lithuanian GPs have taken up new tasks but variation can be reduced. The health care system is still in the midst of transition.

Prevalence and risk factors of genital Chlamydia trachomatis infection.

The aim of the study was to provide a survey and generalization of literature data on the epidemiological situation of Chlamydia trachomatis infection in various countries, preventive screenings and risk factors of the infection. We performed a survey of articles published during 1998-2005 and selected from bibliographical medical search databases presenting data on the prevalence of Chlamydia trachomatis and the main risk factors for this sexually transmitted infection. Chlamydial infection is the most common among sexually transmitted genital infections worldwide. It has been found that the main risk factors for Chlamydia trachomatis infection are age, irregular and/or accidental sexual relationships and change of sexual partners, failure to use or erratic use of barrier contraception during intercourse, and insufficient knowledge about sexual life and care for one's sexual health. Most countries do not have national preventive screening programs or exhaustive information about the prevalence of Chlamydia trachomatis infection. The comparison of the prevalence and incidence of Chlamydia trachomatis infection among different countries is complicated due to the different diagnostic methods and sample selection techniques applied; however, in order to decrease the prevalence of chlamydial infection and its impact on the reproductive health of the society, significant attention should be paid to sexual education, preventive screening of people in high-risk groups, as well as to early diagnostics and timely treatment.

Opinion of patients on accessibility of primary health care centers in Siauliai region.

This article presents the data about the accessibility of primary health care in Siauliai region and about factors related to the patients' perceived access to primary care. The survey was carried out in June 2004, in the context of a joint project of Kaunas University of Medicine and NIVEL, the Netherlands Institute of Health services research. Patients, treated in private and public health care centers in Siauliai region, took part in this survey. The majority of patients are positive about territorial accessibility of primary health care, indicating that it is easy to get to primary health care centers. Patients expressed a high level of satisfaction with the behavior of reception desk personnel. However, they are more critical about waiting time for the general practitioner's consultation: every third noted that they had to wait for far too long. The majority of respondents pointed out that general practitioners rooms and waiting corridors are convenient and comfortable, and that general practitioners have sufficient medical equipment. Most of the patients are very well informed and satisfied with the opening hours of primary health care centers. The main factors related to the patients' evaluations of primary health care accessibility were living place of patients and type of ownership of health care center. Patients living in the towns were less likely to evaluate the accessibility of primary health care centers positively, compared to those living in the city of Siauliai. Patients receiving health care services in private centers were much more positive about access to services than those receiving services in public centers.

[Relationship between the metabolic syndrome, endothelial function and intima-media thickness in asymptomatic middle-aged individuals]. / Rysys tarp metabolinio sindromo, endotelio funkcijos, intimos ir medijos storio bei paciento amziaus.

OBJECTIVE: To evaluate the relation between cardiovascular risk factors, metabolic syndrome, endothelial function and carotid intima-media thickness in asymptomatic middle-aged individuals. MATERIALS AND METHODS: A total of 180 subjects (86 men and 94 women, mean age 38.8+/-0.3 years) have been investigated. Anthropometric, blood pressure measurements have been performed and lipid as well as high sensitivity C-reactive protein blood levels have been tested. The endothelial function was assessed by measuring the vasodilatation of the brachial artery. The carotid intima-media thickness was measured with high resolution B-mode ultrasound imaging. Metabolic syndrome was diagnosed using International Diabetes Federation definition criteria (2005). RESULTS: The metabolic syndrome has been diagnosed in 48 (26.7%) individuals: 28 (32.6%) males and 20 (21.3%) females. Significantly reduced endothelial function has been established in asymptomatic men when compared to women. However, statistically significant decrease (4.84%) in endothelial function in metabolic individuals was detected only among males. In the metabolic patients intima-media of common carotid artery, carotid bulb and internal carotid artery was thicker than in those without metabolic syndrome (0.006, 0.007 and 0.007 cm, respectively) (alpha=0.000, beta=0.01). Endothelial dysfunction and intima-media thickening correlated with increased blood pressure, abdominal circumference and body mass index as well as with elevated blood triglyceride and glucose levels. Intima-media thickness was greater in individuals with impaired endothelial function in all carotid segments tested. No relationship has been observed between total or low-density lipoprotein cholesterol concentrations and endothelial function, intima-media thickening or high sensitivity C-reactive protein levels. CONCLUSIONS: These observations suggest that the metabolic syndrome and/or its components may influence the different initial mechanisms of atherosclerosis--disorder of endothelial function and intima-media thickening. It is presumable that the lipid disorders as well as inflammation may play more significant role in the presence of impaired endothelial function.

[Assessment of health care services quality by medical professionals and patients]. / Ligonines medicinos personalo ir pacientu vertinimai apie mediku ligonineje teikiamas paslaugas.

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.

Changes of patients' satisfaction with the health care services in Lithuanian Health Promoting Hospitals network.

The aim of this study is to evaluate the changes of patients' satisfaction with health care services in Lithuanian Health Promoting Hospitals network. In a survey, which was carried out by Lithuanian Health Promoting Hospitals network, 1271 patients took part in 2000 and 1467 patients in 2002. The patient's satisfaction with health care services was evaluated using a uniform anonymous questionnaire. The patients were asked to evaluate hospital environment (neatness, cleanliness, and food quality), the quality of health personnel work (attentiveness, care, risk factors, and tests used for diagnosis and treatment) rating from 1 (very bad) to 6 (excellent). It was ascertained that, during the period between both surveys, the number of patients who evaluated the sanitary conditions in the ward as excellent and very good, increased from 49.2% to 59.9%, p<0.05. According to the data received from both surveys, the hospital food quality was rated more critically than the hospital environment. The number of patients, who noted that the food quality was satisfactory, decreased from 29.8% to 22.0%, p<0.05 within the period analyzed. However the number of patients who had a positive opinion of the health care personnel's attentiveness and help while explaining the causes and consequences of various illnesses increased. Patients' assessment of the physician work remained the same. The majority of the patients (95.1% in 2000 and 94.9% in 2002) appreciated the overall performance of the physicians, and rated it very good and excellent. The analysis of patients' satisfaction is a simple study of a constituent part of the health care service quality assessment and an objective prerequisite for the improvement of the quality of the health care services.

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.

[Patient satisfaction with the work of the hospital medical personnel]. / Pacientu pasitenkinimas ligonines medicinos personalo darbu.

The article presents the data of patient's satisfaction with the work of nurses and physicians in the hospitals, which belong to Lithuanian Health promotion hospitals network. All nine hospitals of the Lithuanian health promotion hospitals network took part in this study. Altogether 1300 questionnaires were handed out. They have been completed and returned by 1271 patients, i.e. 97.8%. Patients were asked to complete uniform anonymous questionnaire and evaluate the work, behavior and educational activity of nurses and physicians. The majority of respondents assessed the work of nurses and physicians positively, respectively 96.1% and 95.5%. The evaluation of nurses' work depended on patients' sex and the size of the hospital in which they were treated. Male patients and the ones who were treated in big hospitals assessed the work of nurses better than females and patients in smaller hospitals. The evaluation of physicians' work was related to the patients' education and extra payment for health services. Patients, who had higher education and indicated that they had paid additionally, assessed the work of physicians more critically. The majority of patients assessed the behavior of nurses and physicians as very good or excellent, respectively 86.0% and 90.5%. The work of nurses was better evaluated by elderly people and patients treated in big hospitals and as well as in the departments of internal medicine. Patients' satisfaction with the behavior of physicians was associated with patients' education. Better-educated people were more critical in assessing the behavior of physicians. The results of this study have shown that patients' satisfaction depends on many factors. To improve the quality of health care services in hospitals it is necessary to study patients' needs, expectations and factors associated with patients' satisfaction.

[Trends in the prevalence of risk factors of noncommunicable diseases during 1987-1999]. / Letiniu neinfekciniu ligu rizikos veiksniu paplitimo pokyciai 1987-1999 metais.

The trends in the prevalence of hypertension, hypercholesterolemia, overweight and smoking among Lithuanian rural population were assessed from 1987 to 1999. Three independent surveys in 1987, 1993 and 1999 were carried out in five rural regions of Lithuania in random samples of men and women aged 25-64 involving 2695, 1550 and 1838 persons respectively. The risk factors were defined according to the WHO criteria. During the 13 years the prevalence of hypercholesterolemia and overweight has significantly decreased among men (by 23.2% and 4.9% respectively) as well as among women (by 19.9% and 10.7% respectively). The prevalence of hypertension among women has decreased by 9.1%, with no significant changes among men. The prevalence of smoking has increased by 8.9% among women and has not changed among men. Age was positively correlated with the prevalence of all risk factors, except smoking. Younger persons smoked more often than elderly did. Prevalence of risk factors varied by educational level. Hypertension and overweight have been more prevalent among women with incomplete secondary education, than among those with university education. The prevalence of overweight and hypercholesterolaemia has been higher among highly educated men compared to low educated. The inverse relationship between smoking and education has been observed in men. In conclusion, the decreasing trends in the prevalence of some risk factors have been estimated in Lithuania within last decade. Sociodemographic differences in the prevalence of risk factors should be taken into account while developing health promotion and diseases prevention programmes.