Prevalence and determinants of anxiety and depression symptoms in patients with type 2 diabetes in Lithuania.

BACKGROUND: Depression is associated with a variety of diabetes complications, including diabetic retinopathy, nephropathy, neuropathy, and macrovascular complications. The prevalence of the symptoms of anxiety (32%) and depression (22.4%) in patients with diabetes is considerably higher than in general population samples (10%). The aim of this study was to evaluate the prevalence and determinants of anxiety and depression symptoms in patients with type 2 diabetes (T2DM). MATERIAL AND METHODS: This survey was conducted during 2007-2010. In total, 1500 patients were invited to participate in the study. The Hospital Anxiety and Depression Scale (HADS) was used to measure depression and anxiety for the evaluation of the depressive state and anxiety. Statistical analysis was carried out using SPSS 17.0. RESULTS: More than 70% of all respondents who participated in the study had diabetes mellitus complications (72.2%). The prevalence of mild to severe depression score was 28.5% (95% CI 25.7-31.4). The prevalence of anxiety was 42.4% (95% CI 39.3-45.5). Anxiety was more frequent among females (46.8%) than among males (34.7%) (p<0.001). A significant negative trend was observed between prevalence of anxiety and depression, and age and education (p for trend <0.001). CONCLUSIONS: A significant association between depression and diabetic complications was identified (p<0.05). Duration of diabetes was a risk factor significantly associated with higher scores of anxiety among the patients with T2DM.

Civil society engagement in innovation and research through the European Public Health Association.

BACKGROUND: The European Public Health Association (EUPHA) proposed and led PHIRE (Public Health Innovation and Research in Europe), with co-financing by the European Commission, to assess public health innovation and research at national level in Europe. PHIRE was also designed to promote organizational development and capacity building of EUPHA. We assess the success and limitations of using EUPHA's participative structures. METHODS: In total, 30 European countries were included-27 EU countries, Iceland, Norway and Switzerland. EUPHA thematic section presidents were asked to identify country informants to report, through a web-based questionnaire, on eight public health innovations. National public health associations (EUPHA member organizations) were requested to identify their national public health research programmes and calls, review the health research system, coordinate a stakeholder workshop and provide a national report. The section and national reports were assessed for responses and completeness. RESULTS: Half of the final responding CIs were members of EUPHA sections and the other half gained from other sources. Experts declined to respond for reasons including lack of time, knowledge of the innovation or funding. National public health associations held PHIRE workshops with Ministries of Health in 14 countries; information for 10 countries was gained through discussions within the national association, or country visits by PHIRE partners. Six countries provided no response. Some national associations had too weak organizational structures for the work or insufficient financial resources or criticism of the project. CONCLUSION: EUPHA is the leading civil society organization giving support to public health research in Europe. PHIRE created new knowledge and supported organizational development. EUPHA sections gained expert reports on public health innovations in European countries and national public health associations reported on national public health research systems. Significant advances could be made if the European Commission worked more directly with EUPHA's expert members and with the national public health associations.

Impact of innovations in national public health markets in Europe.

BACKGROUND: Social innovations can contribute to health and wellbeing. PHIRE (Public Health Innovation and Research in Europe) investigated the impacts at national level of innovation projects funded by the European Union Public Health Programme. METHODS: Through the European Public Health Association, experts assessed the uptake of the eight public health projects, for 30 European countries. Their reports were assembled by country and, thereafter, national public health associations reviewed the reports. Following stakeholder workshops, or internal and external consultations, 11 national reports were produced which included discussion on the impacts of the public health innovations in national product markets. RESULTS: In 11 countries, there were reports on the eight innovations for 45 (51%) of the possible public health markets. The innovations contributed positively to policy, practice and research, across different levels and in different ways, in 35 (39%) market, while competing innovation activities were recorded in 10 (11%) markets. The workshops also discussed contributing factors and limitations in dissemination and timing for policy cycles. CONCLUSIONS: The impacts of European Union social innovations in public health markets can be identified through national discussions. Further attention should be given to understanding drivers and incentives for successful public health innovations.

Programmes and calls for public health research in European countries.

INTRODUCTION: Public health research, at population and organizational level, needs to be identified independently within 'health' research from biomedicine and life sciences. In PHIRE (Public Health Innovation and Research in Europe), we investigated the extent and character of public health research calls and programmes in European countries. METHODS: Country respondents, identified through national member associations of the European Public Health Association completed a standardized recording instrument. Public health research was defined, and the call period limited to the latest full year (2010). Of the 30 countries included (EU 27 plus Iceland, Norway and Switzerland), there were reports for 25 countries A simple classification of the calls was developed. RESULTS: There were 75 calls and programmes included. Of these, 41 (55%) together were in France and the UK, and 34 in a further 14 countries, while 9 countries reported there were no calls or programmes opened in 2010. Calls were categorized across diseases, behaviours, determinants, services and methodologies. Some calls were broad, while others--particularly in the countries with several calls--were more detailed towards specific issues. Levels of funding varied markedly and were difficult to define. Where stated, in 32 responses, 19 calls were only open to national applicants and 13 from abroad. CONCLUSIONS: Most European countries have competitive programmes and calls relevant for public health research, but they are poorly identified. Only a minority of countries present a wide range of topics and specific fields. Effort is needed to develop classifications for public health programmes and calls for public health research, improve information (including financial) collection to enable systematic comparisons and build greater recognition of public health research within research communities, with national and European research funding organizations, and for practitioners and policymakers.

Competitive funding and structures for public health research in European countries.

INTRODUCTION: The European Union is giving increasing emphasis to research as a driver for innovation and economic development. The European collaborative study PHIRE (Public Health Innovation and Research in Europe) investigated the funding and structures of public health research at national level in European countries. METHODS: Background materials were prepared for national public health associations of European countries to hold workshops or discussions with research and policy stakeholders on their public health research systems. The reports, supplemented from internet sources for 23 EU countries (four did not contribute), provided information for framework analysis. RESULTS: All countries have public funding and administrative structures for research, but structures for public health research are more varied. In most countries, competitive health research funding is controlled by the Ministry of Science, with little input from the Ministry of Health. In four countries, Ministries of Health provide competitive funding alongside Ministries of Science, and in two countries there is a single health research council. There is no comparative reporting of public health research funding, and little connection with European public health research programmes. CONCLUSION: Europe needs a comprehensive picture of national and regional systems of public health research, in order to critically assess them and better adapt to changes and challenges, and to achieve a European Research Area for public health.

Quality of life in relation to social and disease factors in patients with type 2 diabetes in Lithuania.

BACKGROUND: Diabetic patients are more than twice as costly to manage as non-diabetic patients, due mainly to the high costs associated with management of diabetic complications. As in most nations of the world, the number of patients with DM is increasing every year in Lithuania. The aim of this study was to determine relation between quality of the life and disease and social factors of patients with type 2 diabetes in Lithuania. MATERIAL AND METHODS: Independently prepared questions about the subjects of the survey were: gender; age; weight; education; social and marital status; duration of the disease (in years); treatment method; complications; morbidity with arterial hypertension; change in dietary habits after diagnosis of diabetes (started to eat accordingly to recommendations of the therapist); how often nourishment is taken accordingly to recommendations of the therapist; if beginning to exercise after diagnosis of the diabetes; and if exercising, exercises at least 2-3 times per week. Body mass index was calculated as the relation between body mass in kg and height m square (BMI=kg/m2). The hospital anxiety and depression (HAD) scale was used for the evaluation of depression and anxiety. Quality of life of patients was evaluated with the SF-36 questionnaire. We surveyed 1022 patients with type 2 diabetes (372 men and 650 women). Association between quality of the life and explanatory parameters (disease and social factors) were analyzed using the logistic regression analysis model. RESULTS: We found that women had lower scores than men in all fields of quality of life (p<0.001). Peroral treatment had a positive impact on the quality of life (QL) fields of the role limitations due to emotional problems (ORa 0.16. 95% CI 0.07-0.34; p<0.001). Treatment with insulin had a positive effect on restriction of activity because of emotional problems (ORa - 0.23. 95% CI 0.11-0.49; p<0.001) and mental health (ORa - 0.38. 95% CI 0.19-0.78; p=0.008), but had a negative impact on bodily pain (ORa - 3.95. 95% CI 1.41-11.09; p=0.009) and physical health (ORa - 4.14. 95% CI 2.03-8.47; p<0.001). CONCLUSIONS: Age and BMI are less important factors that can influence quality of life. Peroral treatment positively acted on the role limitations due to emotional problems, bodily pain, and mental health, but had a strong negative effect on emotional state.

Prevalence of psychoactive substances use in a Lithuanian women's prison revisited after 5 years.

BACKGROUND: This paper re-examines the prevalence of psychoactive substances (tobacco, alcohol, narcotic drugs) use among inmates in a Lithuanian women's prison. The main goal of this study was to determinate the changes in the use of the psychoactive substances in a women's prison in Lithuania. MATERIAL/METHODS: We accomplished the retesting of the first ever investigation of this kind, carried out in 2004, using the same questionnaire, in the only women's prison in Lithuania. In June 2009, 71 (27.8%) women of 255 inmates of the prison were given questionnaires with information about the aim of the study, stating that the study was voluntary and anonymous, and obtaining permission for release of information. The results were compared with the previous investigation. A statistical analysis was carried out using SPSS 17.0. RESULTS: Tobacco smokers comprised 85.3% of respondents.; the average age at which respondents started to smoke was 14±7.3 years; 57.7% of respondents had tried narcotic drugs at least once; 22.5% of respondents used drugs (in 2004 we had found no drug use in this women's prison); 18.3% of respondents indicated that they narcotic drugs were tried for the first time away, 4.2% - in a custodial establishment. CONCLUSIONS: Psychoactive substances are often used due to their psychological effect. inmates constitute a high-risk group of drug users and distributors of narcotic drugs. Intravenous narcotics stimulating dangerous behavior prevail in Lithuanian prisons. Women in prison are especially prone to smoking.

The prevalence of psychotropic substance use and its influencing factors in Lithuanian penitentiaries.

BACKGROUND: This paper examines the prevalence of psychotropic substance (tobacco, alcohol, narcotic drugs) use among inmates of Lithuanian prisons and the association between drug use and psychosocial factors. MATERIAL/METHODS: The questionnaire used was based on the ESPAD questionnaire, modified to fit the specific respondent group. At the time of the study there were 9634 inmates in Lithuanian penal institutions; 1304 of them participated in the study, 67 (5.2%) were women, 115 (8.8%) boy minors, and 1122 (86%) men. Statistical analysis was carried out using EpilInfo 6.04. RESULTS: It was revealed that 48.7% of the prisoners had used drugs at least once in their lives, 13.8% of prisoners currently used narcotic drugs, and 39.8% had first used illicit (narcotic) drugs in prison. 85.3% currently smoked tobacco and 92.1% had drunk alcohol at least once in their lives. CONCLUSIONS: Psychotropic substances are often used due to their psychological impact. Imprisoned people constitute a high-risk group of drug users and distributors of narcotic drugs. Consequently, the problem of psychotropic substance addiction in penal institutions awakens more concern than the same problem in the general society. Intravenous narcotic drugs stimulating dangerous behavior are prevalent in Lithuanian prisons.